The 10-Year Cost-Effectiveness of Lifestyle Intervention or Metformin for Diabetes Prevention

An intent-to-treat analysis of the DPP/DPPOS

THE DIABETES PREVENTION PROGRAM RESEARCH GROUP*

OBJECTIVE - The Diabetes Prevention Program (DPP) and its Outcomes Study (DPPOS) demonstrated that either intensive lifestyle intervention or metformin could prevent type 2 diabetes in high-risk adults for at least 10 years after randomization. We report the 10-year within trial cost-effectiveness of the interventions.

RESEARCH DESIGN AND METHODS - Data on resource utilization, cost, and quality of life were collected prospectively. Economic analyses were performed from health system and societal perspectives.

RESULTS - Over 10 years, the cumulative, undiscounted per capita direct medical costs of the interventions, as implemented during the DPP, were greater for lifestyle ($4,601) than metformin ($2,300) or placebo ($769). The cumulative direct medical costs of care outside the DPP/DPPOS

were least for lifestyle ($24,563 lifestyle vs. $25,616 metformin vs.  27,468 placebo). The cumulative, combined total direct medical costs were greatest for lifestyle and least for metformin ($29,164 lifestyle vs. $27,915 metformin vs. $28,236 placebo). The cumulative quality-adjusted

life-years (QALYs) accrued over 10 years were greater for lifestyle (6.81) than metformin (6.69) or placebo (6.67). When costs and outcomes were discounted at 3%, lifestyle cost $10,037 per QALY, and metformin had slightly lower costs and nearly the same QALYs as placebo.

CONCLUSIONS - Over 10 years, from a payer perspective, lifestyle was cost-effective and metformin was marginally cost-saving compared with placebo. Investment in lifestyle and metformin interventions for diabetes prevention in high-risk adults provides good value for the money spent.

Diabetes Care 35:723–730, 2012

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