International Journal of Technology Assessment in Health Care

GENERAL ESSAYS

Lifestyle intervention to prevent diabetes in men and women with impaired glucose tolerance is cost-effective

Peter Lindgrena1, Jaana Lindströma2, Jaakko Tuomilehtoa3, Matti Uusitupaa4, Markku Peltonena5, Bengt Jönssona6, Ulf de Fairea7, Mai-Lis Helléniusa8 and The DPS Study Group

a1 Karolinska Institutet and European Health Economics

a2 National Public Health Institute

a3 University of Helsinki

a4 University of Kuopio

a5 National Public Health Institute

a6 Stockholm School of Economics

a7 Karolinska Institutet and Karolinska Hospital

a8 Karolinska Institutet and Stockholm County Council

Abstract

Objectives: The Finnish Diabetes Prevention Study (DPS) was a randomized intervention program that evaluated the effect of intensive lifestyle modification on the development of diabetes mellitus type 2 in patients with impaired glucose tolerance. As such, a program is demanding in terms of resources; it is necessary to assess whether it would be money well spent. This determination was the purpose of this study.

Methods: We developed a simulation model to assess the economic consequences of an intervention like the one studied in DPS in a Swedish setting. The model used data from the trial itself to assess the effect of intervention on the risk of diabetes and on risk factors for cardiovascular disease. Results from the United Kingdom Prospective Diabetes Study were used to estimate the risk of cardiovascular disease and stroke. Cost data were derived from Swedish studies. The intervention was assumed to be applied to eligible patients from a population-based screening program of 60-year-olds in the County of Stockholm from which the baseline characteristics of the patients was used.

Results: The model predicted that implementing the program would be cost-saving from the healthcare payers' perspective. Furthermore, it was associated with an increase in estimated survival of .18 years. Taking into consideration the increased consumption by patients due to their longer survival, the predicted cost-effectiveness ratio was 2,363€ per quality-adjusted life-year gained.

Conclusions: Lifestyle intervention directed toward high-risk subjects would be cost-saving for the healthcare payer and highly cost-effective for society as a whole.

Footnotes

This study was funded by grants from the Stockholm County Council and the Swedish Heart and Lung Foundation. The DPS study was supported by the Finnish Academy, the Novo Nordisk Foundation, the Yrjö Jahnsson Foundation, and the Finnish Diabetes Research Foundation.