Health economics of diabetes prevention

The cost-effectiveness of interventions aimed at halting or slowing the progress of impaired glucose tolerance to type 2 diabetes has been examined in a number of clinical trials and computer modeling simulations. Intensive lifestyle changes (ILC), metformin and acarbose all provide significant health benefits, with ILC appearing to provide larger improvements than either metformin or acarbose. Despite this, all appear affordable. A number of other pharmacological interventions are currently under investigation in the prevention of diabetes. As the clinical results are published, health economic analyses of each new intervention will be required. Head-to head clinical trials will allow more robust direct cost-effectiveness comparisons between different pharmacological approaches to diabetes prevention.

Because the costs of medications, patient management programmes and treatment of complications of type 2 diabetes may vary widely in different countries, country specific analyses of the cost-effectiveness of diabetes prevention is essential. It has been demonstrated that either intensive lifestyle changes (ILC) or pharmacological interventions are significantly better at reducing the incidence of type 2 diabetes versus placebo in people with IGT. The obvious implication of these findings is that early intervention and delay or avoidance of progression to type 2 diabetes is of enormous benefit, both to patients in terms of increasing life expectancy (LE) and quality of life, and potentially in economic terms for society and healthcare payers. In the absence of long-term follow up data (>10 years) from diabetes prevention studies, computer simulation modeling represents the best available approach to evaluate the long-term clinical and economic impact of diabetes prevention programmes.

Within trials studies have also been carried out to assess the economic implications along with the clinical benefits of interventions. A number of research groups have applied modeling technology to project the long-term clinical and cost benefits associated with a number of diabetes prevention interventions.

Summary of Published Cost-Effectiveness Analyses

Study and setting(s)

Year of Costs

Methods

Findings

 

ILC = intensive lifestyle change; LE = life expectancy; QALE = quality-adjusted life expectancy; ICER = incremental cost-effectiveness ratio

References:

1. Quilici S, Chancellor J, Maclaine G, McGuire A, Andersson D, Chiasson JL. Cost-effectiveness of acarbose for the management of impaired glucose tolerance in Sweden. Int J Clin Pract 2005; 59(10): 1143-1152.

2. Caro JJ, Getsios D, Caro I, Klittich WS, O’Brien JA. Economic evaluation of therapeutic interventions to prevent Type 2 diabetes in Canada. Diabet Med 2004; 21(11): 1229-1236.

3. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P et al. Prevention of type 2 diabetes mellitus by changs in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344(18): 1343-1350.

4. Herman WH, Hoerger TJ, Brandie M, Hicks K, Sorensen S, Zhang P et al. The cost effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern Med 2005; 142(5): 323-332.

5. Palmer AJ, Roze S, Valentine WJ, Spinas GA, Shaw JE, Zimmet PZ. Intensive lifestyle changes or metformin in patients with impaired glucose tolerance: modeling the long-term health economic implications of the diabetes prevention program in Australia, France, Germany, Switzerland, and the United Kingdom. Clin Ther 2004; 26(2): 304-321.

6. Mantavani L, Palmer AJ, Morgutti M, Valentine WJ, Renaudin C, Roze S. Long-term cost-effectiveness of the Diabetes Prevention Program in an Italian setting. 40th Annual Meeting of the European Association for the Study of Diabetes, A955. 2004

7. Palmer AJ, Roze S, Valentine WJ, Renaudin C. Cost-effectiveness analysis of the Diabetes Prevention Program in a Spanish setting. Value in Health 7[6], 741 (PDB22).2004.

8. Eddy DM, Schlessinger L, Kahn R. Clinical outcomes and cost-effectiveness of strategies for managing people at high risk for diabetes. Ann Intern Med 2005; 143(4): 251-264.