Journal
DIABETES CARE
Volume 35, Issue 4, Pages 723-730Publisher
AMER DIABETES ASSOC
DOI: 10.2337/dc11-1468
Keywords
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Funding
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health
- NIDDK
- Indian Health Service
- National Institute of Child Health and Human Development
- National Institute on Aging
- National Eye Institute
- National Heart, Lung, and Blood Institute
- Office of Research on Women's Health
- National Institute on Minority Health and Health Disparities
- Centers for Disease Control and Prevention
- American Diabetes Association
- Bristol-Myers Squibb
- Parke-Davis
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OBJECTIVE-The Diabetes Prevention Program (DPP) and its Outcomes Study (DPPOS) demonstrated that either intensive lifestyle intervention or metformin could prevent type 2 diabetes in high-risk adults for at least 10 years after randomization. We report the 10-year within-trial cost-effectiveness of the interventions. RESEARCH DESIGN AND METHODS-Data on resource utilization, cost, and quality of life were collected prospectively. Economic analyses were performed from health system and societal perspectives. RESULTS-Over 10 years, the cumulative, undiscounted per capita direct medical costs of the interventions, as implemented during the DPP, were greater for lifestyle ($4,601) than metformin ($2,300) or placebo ($769). The cumulative direct medical costs of care outside the DPP/DPPOS were least for lifestyle ($24,563 lifestyle vs. $25,616 metformin vs. $27,468 placebo). The cumulative, combined total direct medical costs were greatest for lifestyle and least for metformin ($29,164 lifestyle vs. $27,915 metformin vs. $28,236 placebo). The cumulative quality-adjusted life-years (QALYs) accrued over 10 years were greater for lifestyle (6.81) than metformin (6.69) or placebo (6.67). When costs and outcomes were discounted at 3%, lifestyle cost $10,037 per QALY, and metformin had slightly lower costs and nearly the same QALYs as placebo. CONCLUSIONS-Over 10 years, from a payer perspective, lifestyle was cost-effective and metformin was marginally cost-saving compared with placebo. Investment in lifestyle and metforrnin interventions for diabetes prevention in high-risk adults provides good value for the money spent.
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