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
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.
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.