Appendix Table 3.
Summary Evidence Table of Included Studies Providing Cost-Effectiveness of Combined Diet and Physical Activity Promotion Programs to Reduce Type 2 Diabetes Among Persons at Increased Risk
| Study, Year (Reference); Country | Population Characteristics | Duration of Intervention/Follow-up | Cost Data Source | Benefit Data Source | Effectiveness Outcome | Model | QALY/DALY/LYG | ICER Health System | ICER Society |
|---|---|---|---|---|---|---|---|---|---|
| Within-trial analysis (n=4) | |||||||||
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| |||||||||
| DPP Research Group, 2003 (31); United States* | IGT | 3 y/3 y | Real DPP cost data | Survey, CMS fee schedule | Reduce incidence by 58% | Within trial | 0.072 additional QALY | Individual: $50,694/QALY Group: $14,476/QALY |
Individual: $83,130/QALY Group: $46,820/QALY |
|
| |||||||||
| DPP Research Group, 2012 (19); United States* | Participants with IGT and fasting hyperglycemia, ≥25 y, BMI ≥24 kg/m2, 68% women, 45% minority | 10 y/10 y | Real DPP cost data | Survey | DPPOS trial 0.12 additional QALY |
Within trial | 0.12 additional QALY | Individual $15,846/QALY Group: $1,819/QALY |
Individual $24,373/QALY Group: $10,351/QALY |
|
| |||||||||
| Irvine et al, 2011 (25); United Kingdom | At-risk individuals with diabetes (aged 45–70 y) | 7 mo/7 mo | Real cost data | Survey, NHS reference cost, drug formulary | 0.012 additional QALY | Within trial | 0.012 additional QALY | $40,347/QALY | † |
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| |||||||||
| Sagarra et al, 2014 (29); Spain | Aged 45–75 y, at risk for diabetes with IGT and/or IFG | 4.2 y/4.2 y | Real cost data | Forms | Reduce incidence by 36.5% 0.012 additional QALY |
Within trial | 0.012 additional QALY | $5,359/QALY | † |
| Modeling the trial or extension of trials (n = 16) | |||||||||
|
| |||||||||
| Segal et al, 1998 (32); Australia | Seriously obese Seriously obese with IGT or NGT |
2–3 y/25 y | Based on literature | Survey, insurance scheme | Reducing incidence from 70% to 30% | Markov model | 1 additional LYG | $4,561/LYG | † |
|
| |||||||||
| Caro et al, 2004 (33); Canada | Overweight or obese with IGT | 5 y/10 y | Based on Finnish DPS | Literature, fee schedule, formularies | Based on DPP, Finnish DPS At 5th year, incidence −58% At 10th year, incidence −22% |
Markov model | 0.31 additional LYG | $806/LYG | † |
|
| |||||||||
| Palmer et al, 2004 (34); Australia, France, Germany, Switzerland, United Kingdom | IGT | 3 y/lifetime | DPP apply to fee schedule | Claims | Based on DPP, assuming the effect would not persist beyond the 3rd year | Markov model | 0.08 (Australia) 0.07 (France) 0.07 (Germany) 0.06 (Switzerland) 0.16 (United Kingdom) |
−$8.176/LYG
(Australia) −$11,682/LYG (France) −$15.018/LYG (Germany) −$19,029/LYG (Switzerland) $8.565/LYG (United Kingdom) Mean: −$9.073/LYG |
† |
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| |||||||||
| Eddy et al, 2005 (35); United States* | IGT | Until diabetes onset/30 y | Year 1 to 3: DPP cost Year 4 and beyond: DPP year 3 cost |
Accounting data | Effect of DPP persists as long as receiving the
intervention At end of 30 y, incidence −15% |
Archimedes Diabetes Model | 0.159 additional QALY | Individual $94,752/QALY Group: $18,409/QALY Individual: $221,549/QALY (HMO perspective) Group: $41,879/QALY (HMO perspective) |
– |
|
| |||||||||
| Herman et al, 2005 (36); United States | IGT | Until diabetes onset/lifetime | Year 1 to 3: DPP cost Year 4 and beyond: DPP year 3 cost |
Claims | The effect of DPP persists as long as receiving the
intervention At the end of lifetime, incidence −24% |
Markov model | 0.57 additional QALY | Individual: $1,805/QALY Group: −$10,450/QALY |
Individual: $13,574/QALY |
|
| |||||||||
| Ackerman et al, 2006 (37); United States | Overweight or obese 50-year-old adults with IGT | Until diabetes onset/lifetime | Year 1 to 3: DPP cost Year 4 and beyond: DPP year 3 cost |
Claims | Based on DPP The DPP effect will continue as long as receiving intervention |
Markov model | Age 50 y: 0.59 additional QALY Age 65 y: 0.27 additional QALY |
Age 50 y: $2,070/QALY Age 65 y: $2,536/QALY |
† |
|
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| Hoerger et al, 2007 (38); United States* | Aged 45–74 y, overweight and obese (BMI
≥25 kg/m2) Groups |
Until diabetes onset/lifetime | Year 1 to 3: DPP cost Year 4 and beyond: DPP year 3 cost |
Claims | The effect of DPP persists as long as receiving the intervention | Markov model | 0.040 additional QALY | Individual: $14,154/QALY Group: $396/QALY |
Individual: $28,849/QALY |
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| Jacobs-van der Bruggen et al, 2007 (30); Netherlands | Adults with moderate risks for diabetes, obese adults aged 30–70 y | 3 y/lifetime | 2 published Dutch trials | Literature | BMI: −0.3 to −1.5
kg/m2 Physical activity: 50%−75% more from inactive to moderately active, 20% more from moderately to active |
Markov model | 1.17 additional QALY | $8,735/QALY | † |
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| Lindaren et al, 2007 (39); Sweden | IGT Age 60 y BMI >25 kg/m2, FPG >6.1 |
6 y/lifetime | Finnish DPS | Literature | Based on Finnish DPS; no lasting effect if the intervention stops | Markov model | 0.2 additional QALY | $14,852/LYG $13,367/QALY |
$6,756/LYG $6,080/QALY |
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| Gillies et al, 2008 (40); United Kingdom | NR | Until diabetes onset/50 y | A systematic review of weight loss programs | Literature, such as UKPDS | Hazard ratio, −0.649 from review | Markov model | 0.05 additional LYG 0.09 additional QALY |
$25,083/LYG $14,352/QALY |
† |
|
| |||||||||
| Bertram et al, 2010(41); Australia | Age >55 y, or age >45 y plus high BMI, family history of type 2 diabetes mellitus or hypertension; people from “high-risk” groups | Average trial period/lifetime | A systematic review and meta-analysis of lifestyle interventions | Benefit schedule | Based on meta-analysis Relative risk: 0.49 Assuming 10% decay of effect after the intervention |
Microsimulation model | 0.05 additional DALY averted | $21,195/DALY | † |
|
| |||||||||
| Smith et al, 2010 (24); United States | BMI ≥25 kg/m2 and metabolic syndrome | 3 mo/3 y | A community-based DPP in Pennsylvania, United States | Literature (DPP, UKPDS, Framingham Heart Study) | By 1 y, metabolic risk:
−16.2% By 3 y, risk:−19% |
Markov model | 0.01 QALY | $5,494/QALY | † |
|
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| Neumann et al, 2011 (42); Germany | FINDRISC between 11–20, or FINDRISC ≥21 and without diagnosis of diabetes | 5 y/lifetime | SDPP | CODE-2 study calculation of average annual direct health care costs of persons with NGT, IGT, and type 2 diabetes | Based on literature, such as PREDIAS and SDPP in
Germany Assuming the effectiveness of the intervention lasts only for 1 y after the intervention (disappears at 7th year) |
Markov model | 0.02–0.03 QALY depending on sex and age | † | Age 30 y: −$41,772/QALY for men,
−$52,136/QALY for women Age 50 y: −$25,079/QALY for men, −$35,217/QALY for women Age 70 y: $39,666/QALY for men, $32,259/QALY for women |
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| Palmer et al, 2012 (43); Australia | NR | 10 y/lifetime | DPPOS, using medical benefits schedule in Australia | Survey, unit cost data in Australia | Based on DPPOS trial 0.12 additional QALY | Semi-Markov simulation | 0.3 LYG 0.12 QALY |
−$234/LYG −$411/QALY |
† |
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| Feldman et al, 2013 (28); Sweden | NR | 1 y/lifetime | Based on a lifestyle trial in Sweden | Swedish previously published studies | Based on the KMSP in Sweden Assuming effect continued at year 2 then gradually decreased, reaching the level at the start in year 5 and beyond (e.g., −0.4 to −1.1) in BMI in different risk groups +2 to −7 in waist circumference +0.2 to −0.6 in fasting glucose |
Markov model | 0.05–0.14 additional QALY | $4,104/QALY for men with high
risk $23,327/QALY for women with high risk |
Cost-saving for men with high
risk $22,647/QALY for women with high risk |
|
| |||||||||
| Png and Yoong, 2014 (44); Singapore | IGT | 3 y/3 y | DPP, applying unit cost obtained from the Singapore
National University Hospital cost repository Singapore Household Expenditure Survey |
Singapore National University Hospital cost repository | Based on 3-y DPP trial, not explicitly reporting the risk reduction | Markov model | 0.05 QALY | $17,614/QALY | $37,580/QALY |
| Modeling nationwide diabetes prevention programs (n = 2) | |||||||||
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| Colagiuri and Walker, 2008 (45); Australia | Australians aged 45–74 y | 10 y/1 0 y | An unspecified “lifestyle program” at Australia, $500 per person per year | Literature, such as UKPDS | Diabetes incidence in IGT:
−60% In IFG: −30% |
Markov model | 36,009 additional DALY averted in the whole nation | $50,707/DALY | † |
|
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| Zhuo et al, 2012 (46); United States | 18–64 y and 65–84 y U.S. population | Until diabetes onset/25 y | Year 1: Based on YMCA-DPP Year beyond: Based on DPPOS maintenance period |
Claims | Year 1: Diabetes incidence: −40% to
−50% Year 2: Diabetes incidence: −40% to −50% Year 3 and beyond: −10 to −15% |
Markov model | 0.04 additional LYG 0.03 additional QALY |
16–64 y:
−$8,378/QALY 65–84 y: −$5,760/QALY |
† |
BMI = body mass index; CMS = Centers for Medicare & Medicaid Services; CODE-2 = Cost of Diabetes in Europe–Type 2; DALY = disability-adjusted life-year; DPP = Diabetes Prevention Program; DPPOS = Diabetes Prevention Program Outcomes Study; DPS = Diabetes Prevention Study; FINDRISC = Finnish Type 2 Diabetes Risk Score; FPG = fasting plasma glucose; ICER = incremental cost-effectiveness ratio; IFG = impaired fasting glucose; IGT = impaired glucose tolerance; KMSP = Kalmar Metabolic Syndrome Program; LYG = life-year gained; NGT = normal glucose tolerance; NHS = National Health Service; NR = not reported; PREDIAS = Prevention of Diabetes Self-management Program; QALY = quality-adjusted life-year; SDPP = Saxon Diabetes Prevention Programme; UKPDS = United Kingdom Prospective Diabetes Study; YMCA = Young Men’s Christian Association.
*
Study reported from “societal perspective”; however, it was actually from “health system perspective” because only costs to the health system were included.
†
Study did not include or report the cost or cost-effectiveness for the category.