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Targeting of the diabetes prevention program leads to substantial benefits when capacity is constrained.
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- Author(s): Olchanski N;Olchanski N; van Klaveren D; van Klaveren D; Cohen JT; Cohen JT; Wong JB; Wong JB; Wong JB; Ruthazer R; Ruthazer R; Kent DM; Kent DM
- Source:
Acta diabetologica [Acta Diabetol] 2021 Jun; Vol. 58 (6), pp. 707-722. Date of Electronic Publication: 2021 Jan 30.- Publication Type:
Journal Article- Language:
English - Source:
- Additional Information
- Source: Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9200299 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-5233 (Electronic) Linking ISSN: 09405429 NLM ISO Abbreviation: Acta Diabetol Subsets: MEDLINE
- Publication Information: Publication: Berlin : Springer Verlag
Original Publication: Berlin : Springer International, c1991- - Subject Terms: Patient Selection* ; Primary Prevention*/economics ; Primary Prevention*/methods ; Primary Prevention*/organization & administration ; Primary Prevention*/statistics & numerical data; Diabetes Mellitus, Type 2/*prevention & control ; Prediabetic State/*therapy; Adult ; Cohort Studies ; Cost-Benefit Analysis ; Diabetes Mellitus, Type 2/economics ; Diabetes Mellitus, Type 2/epidemiology ; Female ; Health Services Accessibility/economics ; Health Services Accessibility/organization & administration ; Health Services Accessibility/statistics & numerical data ; Humans ; Hypoglycemic Agents/economics ; Hypoglycemic Agents/therapeutic use ; Life Expectancy ; Life Style ; Male ; Metformin/economics ; Metformin/therapeutic use ; Middle Aged ; Prediabetic State/economics ; Prediabetic State/epidemiology ; Quality of Life ; Risk Factors ; Standard of Care/economics ; Standard of Care/organization & administration ; Standard of Care/standards ; United States/epidemiology
- Abstract: Objective: Approximately 84 million people in the USA have pre-diabetes, but only a fraction of them receive proven effective therapies to prevent type 2 diabetes. We estimated the value of prioritizing individuals at highest risk of progression to diabetes for treatment, compared to non-targeted treatment of individuals meeting inclusion criteria for the Diabetes Prevention Program (DPP).
Methods: Using microsimulation to project outcomes in the DPP trial population, we compared two interventions to usual care: (1) lifestyle modification and (2) metformin administration. For each intervention, we compared targeted and non-targeted strategies, assuming either limited or unlimited program capacity. We modeled the individualized risk of developing diabetes and projected diabetic outcomes to yield lifetime costs and quality-adjusted life expectancy, from which we estimated net monetary benefits (NMB) for both lifestyle and metformin versus usual care.
Results: Compared to usual care, lifestyle modification conferred positive benefits and reduced lifetime costs for all eligible individuals. Metformin's NMB was negative for the lowest population risk quintile. By avoiding use when costs outweighed benefits, targeted administration of metformin conferred a benefit of $500 per person. If only 20% of the population could receive treatment, when prioritizing individuals based on diabetes risk, rather than treating a 20% random sample, the difference in NMB ranged from $14,000 to $20,000 per person.
Conclusions: Targeting active diabetes prevention to patients at highest risk could improve health outcomes and reduce costs compared to providing the same intervention to a similar number of patients with pre-diabetes without targeted selection. - References: Herman WH, Edelstein SL, Ratner RE et al (2013) Effectiveness and cost-effectiveness of diabetes prevention among adherent participants. Am J Manag Care 19:194–202. (PMID: 235447613985133)
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- Contributed Indexing: Keywords: Diabetes prevention; Economic analysis; Heterogeneity of treatment effect; Lifestyle modification; Risk based; Type 2 diabetes; Value
- Accession Number: 0 (Hypoglycemic Agents)
9100L32L2N (Metformin) - Publication Date: Date Created: 20210131 Date Completed: 20210614 Latest Revision: 20221109
- Publication Date: 20231215
- Accession Number: PMC8276501
- Accession Number: 10.1007/s00592-021-01672-3
- Accession Number: 33517494
- Source:
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