Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
The European Journal of Health Economics
Published in: The European Journal of Health Economics 7/2017

Open Access 01-09-2017 | Original Paper

The cost-effectiveness of interventions targeting lifestyle change for the prevention of diabetes in a Swedish primary care and community based prevention program

Authors: Anne Neumann, Lars Lindholm, Margareta Norberg, Olaf Schoffer, Stefanie J. Klug, Fredrik Norström

Published in: The European Journal of Health Economics | Issue 7/2017

Login to get access

Abstract

Background

Policymakers need to know the cost-effectiveness of interventions to prevent type 2 diabetes (T2D). The objective of this study was to estimate the cost-effectiveness of a T2D prevention initiative targeting weight reduction, increased physical activity and healthier diet in persons in pre-diabetic states by comparing a hypothetical intervention versus no intervention in a Swedish setting.

Methods

A Markov model was used to study the cost-effectiveness of a T2D prevention program based on lifestyle change versus a control group where no prevention was applied. Analyses were done deterministically and probabilistically based on Monte Carlo simulation for six different scenarios defined by sex and age groups (30, 50, 70 years). Cost and quality adjusted life year (QALY) differences between no intervention and intervention and incremental cost-effectiveness ratios (ICERs) were estimated and visualized in cost-effectiveness planes (CE planes) and cost-effectiveness acceptability curves (CEA curves).

Results

All ICERs were cost-effective and ranged from 3833 €/QALY gained (women, 30 years) to 9215 €/QALY gained (men, 70 years). The CEA curves showed that the probability of the intervention being cost-effective at the threshold value of 50,000 € per QALY gained was very high for all scenarios ranging from 85.0 to 91.1%.

Discussion/conclusion

The prevention or the delay of the onset of T2D is feasible and cost-effective. A small investment in healthy lifestyle with change in physical activity and diet together with weight loss are very likely to be cost-effective.
Appendix
Available only for authorised users
Literature
1.
International Diabetes Federation: Diabetes atlas update 2014 (2014)
2.
Brinks, R., Tamayo, T., Kowall, B., Rathmann, W.: Prevalence of type 2 diabetes in Germany in 2040: estimates from an epidemiological model. Eur. J. Epidemiol. 27, 791–797 (2012)CrossRefPubMed
3.
WHO: Definition, diagnosis and classification of diabetes mellitus and its complications, part 1: diagnosis and classification of diabetes mellitus, vol. 99.2, pp. 1–59. World Health Organization, Geneva (1999)
4.
Postmus, D., de Graaf, G., Hillege, H.L., Steyerberg, E.W., Buskens, E.: A method for the early health technology assessment of novel biomarker measurement in primary prevention programs. Stat. Med. 31, 2733–2744 (2012)CrossRefPubMed
5.
Knowler, W.C., Barrett-Connor, E., Fowler, S.E., Hamman, R.F., Lachin, J.M., Walker, E.A., Nathan, D.M.: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N. Engl. J. Med. 346, 393–403 (2002)CrossRefPubMed
6.
Tuomilehto, J., Lindstrom, J., Eriksson, J.G., Valle, T.T., Hamalainen, H., Ilanne-Parikka, P., Keinanen-Kiukaanniemi, S., Laakso, M., Louheranta, A., Rastas, M., et al.: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N. Engl. J. Med. 344, 1343–1350 (2001)CrossRefPubMed
7.
Kosaka, K., Noda, M., Kuzuya, T.: Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males. Diabetes Res. Clin. Pract. 67, 152–162 (2005)CrossRefPubMed
8.
Ramachandran, A., Snehalatha, C., Mary, S., Mukesh, B., Bhaskar, A.D., Vijay, V.: The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 49, 289–297 (2006)CrossRefPubMed
9.
Eriksson, K.F., Lindgarde, F.: Prevention of type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercise. The 6-year Malmo feasibility study. Diabetologia 34, 891–898 (1991)CrossRefPubMed
10.
Pan, X.R., Li, G.W., Hu, Y.H., Wang, J.X., Yang, W.Y., An, Z.X., Hu, Z.X., Lin, J., Xiao, J.Z., Cao, H.B., et al.: Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 20, 537–544 (1997)CrossRefPubMed
11.
Mensink, M., Feskens, E.J., Saris, W.H., De Bruin, T.W., Blaak, E.E.: Study on Lifestyle Intervention and Impaired Glucose Tolerance Maastricht (SLIM): preliminary results after one year. Int. J. Obes. Relat. Metab. Disord. 27, 377–384 (2003)CrossRefPubMed
12.
Shin, J.A., Lee, J.H., Kim, H.S., Choi, Y.H., Cho, J.H., Yoon, K.H.: Prevention of diabetes: a strategic approach for individual patients. Diabetes/Metab. Res. Rev. 28(Suppl 2), 79–84 (2012)CrossRef
13.
Saha, S., Gerdtham, U.G., Johansson, P.: Economic evaluation of lifestyle interventions for preventing diabetes and cardiovascular diseases. Int. J. Environ. Res. Pub. Health. 7, 3150–3195 (2010)CrossRef
14.
Smith, K.J., Hsu, H.E., Roberts, M.S., Kramer, M.K., Orchard, T.J., Piatt, G.A., Seidel, M.C., Zgibor, J.C., Bryce, C.L.: Cost-effectiveness analysis of efforts to reduce risk of type 2 diabetes and cardiovascular disease in southwestern Pennsylvania, 2005–2007. Prev. Chronic Dis. 7, A109 (2010)PubMedPubMedCentral
15.
Ackermann, R.T., Marrero, D.G., Hicks, K.A., Hoerger, T.J., Sorensen, S., Zhang, P., Engelgau, M.M., Ratner, R.E., Herman, W.H.: An evaluation of cost sharing to finance a diet and physical activity intervention to prevent diabetes. Diabetes Care 29, 1237–1241 (2006)CrossRefPubMed
16.
Dall, T.M., Storm, M.V., Semilla, A.P., Wintfeld, N., O’Grady, M., Narayan, K.M.: Value of lifestyle intervention to prevent diabetes and sequelae. Am. J. Prev. Med. 48, 271–280 (2015)CrossRefPubMed
17.
Lindgren, P., Lindstrom, J., Tuomilehto, J., Uusitupa, M., Peltonen, M., Jonsson, B., de Faire, U., Hellenius, M.L.: Lifestyle intervention to prevent diabetes in men and women with impaired glucose tolerance is cost-effective. Int. J. Technol. Assess. Health Care 23, 177–183 (2007)CrossRefPubMed
18.
Liu, X., Li, C., Gong, H., Cui, Z., Fan, L., Yu, W., Zhang, C., Ma, J.: An economic evaluation for prevention of diabetes mellitus in a developing country: a modelling study. BMC Pub. Health 13, 729 (2013)CrossRef
19.
Schaufler, T.M., Wolff, M.: Cost effectiveness of preventive screening programmes for type 2 diabetes mellitus in Germany. Appl. Health Econ. Health Policy 8, 191–202 (2010)CrossRefPubMed
20.
Neumann, A., Schwarz, P., Lindholm, L.: Estimating the cost-effectiveness of lifestyle intervention programmes to prevent diabetes based on an example from Germany: Markov modelling. Cost. Eff. Resour. Alloc.: C/E 9, 17 (2011)CrossRefPubMedPubMedCentral
21.
Palmer, A.J., Tucker, D.M.: Cost and clinical implications of diabetes prevention in an Australian setting: a long-term modeling analysis. Prim. Care Diabetes 6, 109–121 (2012)CrossRefPubMed
22.
Neumann, A., Norberg, M., Schoffer, O., Norström, F., Johansson, I., Klug, S.J., Lindholm, L.: Risk equations for the development of worsened glucose status and type 2 diabetes mellitus in a Swedish intervention program. BMC Pub. Health 13, 1 (2013)CrossRef
23.
Neumann, A., Schoffer, O., Norstrom, F., Norberg, M., Klug, S.J., Lindholm, L.: Health-related quality of life for pre-diabetic states and type 2 diabetes mellitus: a cross-sectional study in Vasterbotten, Sweden. Health Qual. Life Outcomes 12, 150 (2014)CrossRefPubMedPubMedCentral
24.
Vaatainen, S., Keinanen-Kiukaanniemi, S., Saramies, J., Uusitalo, H., Tuomilehto, J., Martikainen, J.: Quality of life along the diabetes continuum: a cross-sectional view of health-related quality of life and general health status in middle-aged and older Finns. Qual. Life Res. 1(23), 1935–1944 (2014)CrossRef
25.
Faerch, K., Witte, D.R., Tabak, A.G., Perreault, L., Herder, C., Brunner, E.J., Kivimaki, M., Vistisen, D.: Trajectories of cardiometabolic risk factors before diagnosis of three subtypes of type 2 diabetes: a post hoc analysis of the longitudinal Whitehall II cohort study. Lancet Diabetes Endocrinol. 1, 43–51 (2013)CrossRefPubMed
26.
Norris SL, Kansagara D, Bougatsos C, Nygren P, Fu R: In screening for type 2 diabetes mellitus: update of 2003 systematic evidence review for the US preventive services task force. Rockville (MD); 2008: U.S. Preventive Services Task Force evidence syntheses, formerly systematic evidence reviews]
27.
Knowler, W.C., Fowler, S.E., Hamman, R.F., Christophi, C.A., Hoffman, H.J., Brenneman, A.T., Brown-Friday, J.O., Goldberg, R., Venditti, E., Nathan, D.M.: 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 374, 1677–1686 (2009)CrossRefPubMed
28.
29.
Herman, W.H., Edelstein, S.L., Ratner, R.E., Montez, M.G., Ackermann, R.T., Orchard, T.J., Foulkes, M.A., Zhang, P., Saudek, C.D., Brown, M.B.: Effectiveness and cost-effectiveness of diabetes prevention among adherent participants. Am. J. Manag. Care. 19, 194–202 (2013)PubMedPubMedCentral
30.
Lindstrom, J., Ilanne-Parikka, P., Peltonen, M., Aunola, S., Eriksson, J.G., Hemio, K., Hamalainen, H., Harkonen, P., Keinanen-Kiukaanniemi, S., Laakso, M., et al.: Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 368, 1673–1679 (2006)CrossRefPubMed
31.
32.
Brazier, J.E., Roberts, J.: The estimation of a preference-based measure of health from the SF-12. Med. Care 42, 851–859 (2004)CrossRefPubMed
33.
Ringborg, A., Martinell, M., Stalhammar, J., Yin, D.D., Lindgren, P.: Resource use and costs of type 2 diabetes in Sweden—estimates from population-based register data. Int. J. Clin. Pract. 62, 708–716 (2008)CrossRefPubMed
34.
Henriksson, F., Jonsson, B.: Diabetes: the cost of illness in Sweden. J. Intern. Med. 244, 461–468 (1998)CrossRefPubMed
35.
Nichols, G.A., Glauber, H.S., Brown, J.B.: Type 2 diabetes: incremental medical care costs during the 8 years preceding diagnosis. Diabetes Care 23, 1654–1659 (2000)CrossRefPubMed
36.
American Diabetes Association: Economic costs of diabetes in the US in 2007. Diabetes Care 31, 596–615 (2008)CrossRef
37.
Palmer, A.J., Roze, S., Valentine, W.J., Spinas, G.A., Shaw, J.E., Zimmet, P.Z.: 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. 26, 304–321 (2004)CrossRefPubMed
38.
TPBB: General guidelines for economic evaluations from the Pharmaceutical Benefits Board (LFNAR 2003:2). 2003
39.
Briggs, A., Claxton, K., Mark, S.: Decision modelling for health economic evaluation. Oxford University Press, New York (2006)
40.
Witt, C.M., Reinhold, T., Jena, S., Brinkhaus, B., Willich, S.N.: Cost-effectiveness of acupuncture in women and men with allergic rhinitis: a randomized controlled study in usual care. Am. J. Epidemiol. 169, 562–571 (2009)CrossRefPubMed
41.
42.
Forster, M., Veerman, J.L., Barendregt, J.J., Vos, T.: Cost-effectiveness of diet and exercise interventions to reduce overweight and obesity. Int. J. Obes. 35, 1071–1078 (2011)CrossRef
43.
Haussler, J., Breyer, F.: Does diabetes prevention pay for itself? Evaluation of the MOBILIS program for obese persons. Eur. J. Health Econ. 17(4), 379–389 (2015)CrossRefPubMed
44.
De Smedt, D., De Cocker, K., Annemans, L., De Bourdeaudhuij, I., Cardon, G.: A cost-effectiveness study of the community-based intervention ‘10,000 Steps Ghent’. Pub. Health Nutr. 15, 442–451 (2012)CrossRef
45.
Johansson, P., Ostenson, C.G., Hilding, A.M., Andersson, C., Rehnberg, C., Tillgren, P.: A cost-effectiveness analysis of a community-based diabetes prevention program in Sweden. Int. J. Technol. Assess. Health Care 25, 350–358 (2009)CrossRefPubMed
46.
Henriksson, F., Agardh, C.D., Berne, C., Bolinder, J., Lonnqvist, F., Stenstrom, P., Ostenson, C.G., Jonsson, B.: Direct medical costs for patients with type 2 diabetes in Sweden. J. Intern. Med. 248, 387–396 (2000)CrossRefPubMed
47.
Saito, T., Watanabe, M., Nishida, J., Izumi, T., Omura, M., Takagi, T., Fukunaga, R., Bandai, Y., Tajima, N., Nakamura, Y., et al.: Lifestyle modification and prevention of type 2 diabetes in overweight Japanese with impaired fasting glucose levels: a randomized controlled trial. Arch. Intern. Med. 171, 1352–1360 (2011)CrossRefPubMed
48.
Li, G., Zhang, P., Wang, J., Gregg, E.W., Yang, W., Gong, Q., Li, H., Jiang, Y., An, Y., Shuai, Y., et al.: The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet 371, 1783–1789 (2008)CrossRefPubMed
49.
Schwarz, P.E., Riemenschneider, H.: Slowing down the progression of type 2 diabetes: we need fair, innovative, and disruptive action on environmental and policy levels! Diabetes Care 39(Suppl 2), S121–S126 (2016)CrossRefPubMed
50.
Wareham, N.J., Herman, W.H.: The clinical and public health challenges of diabetes prevention: a search for sustainable solutions. PLoS Med 13, e1002097 (2016)CrossRefPubMedPubMedCentral
Metadata
Title
The cost-effectiveness of interventions targeting lifestyle change for the prevention of diabetes in a Swedish primary care and community based prevention program
Authors
Anne Neumann
Lars Lindholm
Margareta Norberg
Olaf Schoffer
Stefanie J. Klug
Fredrik Norström
Publication date
01-09-2017
Publisher
Springer Berlin Heidelberg
Published in
The European Journal of Health Economics / Issue 7/2017
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-016-0851-9

Other articles of this Issue 7/2017

The European Journal of Health Economics 7/2017 Go to the issue

Original Paper

The social cost of chronic kidney disease in Italy

Original Paper

The social cost of drugs in France in 2010

Original Paper

Healthier lifestyles after retirement in Europe? Evidence from SHARE

Original Paper

Does drug price-regulation affect healthcare expenditures?

Original Paper

Health-economic evaluation of home telemonitoring for COPD in Germany: evidence from a large population-based cohort

Editorial

On vaccination programs in the EU Member States: the case of the human papilloma virus