International Journal of Technology Assessment in Health Care

General Essays

A cost-effectiveness analysis of a community-based diabetes prevention program in Sweden

Pia Johanssona1, Claes-Göran Östensona1, Agneta M. Hildinga1, Camilla Anderssona1, Clas Rehnberga1 and Per Tillgrena1

a1 Karolinska Institutet


Objectives: Lifestyle changes to prevent type 2 diabetes among high-risk persons have been shown to be cost-effective. This study investigates the cost-effectiveness of a community-based program promoting general population lifestyle changes to prevent diabetes.

Methods: The 10-year program was implemented in three municipalities in Sweden. Effectiveness was measured with a quasiexperimental cohort design, that is, risk factor levels in a population group aged 36–56 years at baseline and 8–10 years later (2,149 men; 3,092 women) in the program municipalities and a control area were compared. The incremental cost-utility analysis included future diabetes and cardiovascular disease-related health effects and societal costs (discounted 3 percent), estimated by a Markov model.

Results: In all areas, risk factor levels increased during follow-up, leading to increased societal costs of between SEK40,000 and 90,000 (1 Euro 2004 = SEK9.13; 1 US$ = SEK 7.35) and quality-adjusted life-year (QALY) losses between 0.12 and 0.48 per individual. Compared with the control area, the cost increases and QALY losses for women were more favorable in two program areas but less favorable in one, and less favorable for men in both areas (data unavailable for one municipality). The findings indicate that the program was cost-effective in only two female study groups.

Conclusions: Conflicting results on the cost-effectiveness of the program were obtained. As several potentially valuable aspects of the program are not included in the cost-effectiveness analysis, the societal value of the program might not be adequately reflected.


This study was funded by the Stockholm County Council. We gratefully acknowledge the contributions of Lina Eriksson, presently at the Swedish National Institute of Public Health; Cecilia Lindvall, presently at the Stockholm County Council; Gunilla Bjärås; Lena Kanström, Karolinska Institutet; as well as the local project leaders in the program municipalities.