Costs Associated With the Primary Prevention of Type 2 Diabetes Mellitus in the Diabetes Prevention Program

The Diabetes Prevention Program Coordinating Center, Biostatistics Center, George Washington University, Rockville, Maryland 20852, USA.
Diabetes Care (Impact Factor: 8.42). 02/2003; 26(1):36-47. DOI: 10.2337/diacare.26.1.36
Source: PubMed


To describe the costs of the Diabetes Prevention Program (DPP) interventions to prevent or delay type 2 diabetes.
We describe the direct medical costs, direct nonmedical costs, and indirect costs of the placebo, metformin, and intensive lifestyle interventions over the 3-year study period of the DPP. Resource use and cost are summarized from the perspective of a large health system and society. Research costs are excluded.
The direct medical cost of laboratory tests to identify one subject with impaired glucose tolerance (IGT) was $139. Over 3 years, the direct medical costs of the interventions were $79 per participant in the placebo group, $2,542 in the metformin group, and $2,780 in the lifestyle group. The direct medical costs of care outside the DPP were $272 less per participant in the metformin group and $432 less in the lifestyle group compared with the placebo group. Direct nonmedical costs were $9 less per participant in the metformin group and $1,445 greater in the lifestyle group compared with the placebo group. Indirect costs were $230 greater per participant in the metformin group and $174 less in the lifestyle group compared with the placebo group. From the perspective of a health system, the cost of the metformin intervention relative to the placebo intervention was $2,191 per participant and the cost of the lifestyle intervention was $2,269 per participant over 3 years. From the perspective of society, the cost of the metformin intervention relative to the placebo intervention was $2,412 per participant and the cost of the lifestyle intervention was $3,540 per participant over 3 years.
The metformin and lifestyle interventions are associated with modest incremental costs compared with the placebo intervention. The evaluation of costs relative to health benefits will determine the value of these interventions to health systems and society.

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    • "The cost-effectiveness of the original DPP treatments [8-10] has been addressed and a burgeoning dissemination literature demonstrates that standardized adaptations are feasible and effective in producing weight losses of roughly 3-7%, with decreased cardio-metabolic risk, at least in the short term [11-30]. The Centers for Disease Control (CDC) National Diabetes Prevention Program (NDPP) and others have focused on training a competent workforce to implement DPP-adapted interventions with fidelity, and build infrastructure to sustain group based diabetes prevention programs [26,31]. "
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    ABSTRACT: Individual barriers to weight loss and physical activity goals in the Diabetes Prevention Program, a randomized trial with 3.2 years average treatment duration, have not been previously reported. Evaluating barriers and the lifestyle coaching approaches used to improve adherence in a large, diverse participant cohort can inform dissemination efforts. Lifestyle coaches documented barriers and approaches after each session (mean session attendance = 50.3 +/- 21.8). Subjects were 1076 intensive lifestyle participants (mean age = 50.6 years; mean BMI = 33.9 kg/m2; 68% female, 48% non-Caucasian). Barriers and approaches used to improve adherence were ranked by the percentage of the cohort for whom they applied. Barrier groupings were also analyzed in relation to baseline demographic characteristics. Top weight loss barriers reported were problems with self-monitoring (58%); social cues (58%); holidays (54%); low activity (48%); and internal cues (thought/mood) (44%). Top activity barriers were holidays (51%); time management (50%); internal cues (30%); illness (29%), and motivation (26%). The percentage of the cohort having any type of barrier increased over the long-term intervention period. A majority of the weight loss barriers were significantly associated with younger age, greater obesity, and non-Caucasian race/ethnicity (p-values vary). Physical activity barriers, particularly thought and mood cues, social cues and time management, physical injury or illness and access/weather, were most significantly associated with being female and obese (p < 0.001 for all). Lifestyle coaches used problem-solving with most participants (>=75% short-term; > 90% long term) and regularly reviewed self-monitoring skills. More costly approaches were used infrequently during the first 16 sessions (<=10%) but increased over 3.2 years. Behavioral problem solving approaches have short and long term dissemination potential for many kinds of participant barriers. Given minimal resources, increased attention to training lifestyle coaches in the consistent use of these approaches appears warranted.
    International Journal of Behavioral Nutrition and Physical Activity 02/2014; 11(1):16. DOI:10.1186/1479-5868-11-16 · 4.11 Impact Factor
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    • "The high prevalence rates of family history of diabetes, obesity and sedentary lifestyle raise the need for a lifestyle intervention targeting individuals at risk of T2D. It is well established that diet- and physical activity-based lifestyle interventions are effective in preventing or delaying the onset of T2D in the short term [11,12] and in the long term [13-16]. However, there are currently no routines or programs to assist health care providers in improving lifestyle in individuals at risk of T2D who come from the Middle East and have a different cultural and socioeconomic background. "
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    ABSTRACT: Studies have shown that lifestyle interventions are effective in preventing or delaying the onset of type 2 diabetes in high-risk patients. However, research on the effectiveness of lifestyle interventions in high-risk immigrant populations with different cultural and socioeconomic backgrounds is scarce. The aim was to design a culturally adapted lifestyle intervention for an immigrant population and to evaluate its effectiveness and cost-effectiveness.Methods/designIn this randomized controlled trial, 308 participants (born in Iraq, living in Malmo, Sweden and at high risk of type 2 diabetes) will be allocated to either a culturally adapted intervention or a control group. The intervention will consist of 10 group counseling sessions focusing on diet, physical activity and behavioral change over 6 months, and the offer of exercise sessions. Cultural adaptation includes gender-specific exercise sessions, and counseling by a health coach community member. The control group will receive the information about healthy lifestyle habits provided by the primary health care center. The primary outcome is change in fasting glucose level. Secondary outcomes are changes in body mass index, insulin sensitivity, physical activity, food habits and health-related quality of life. Measurements will be taken at baseline, after 3 and 6 months. Data will be analyzed by the intention-to-treat approach. The cost-effectiveness during the trial period and over the longer term will be assessed by simulation modeling from patient, health care and societal perspectives. This study will provide a basis to measure the effectiveness of a lifestyle intervention designed for immigrants from the Middle East in terms of improvement in glucose metabolism, and will also assess its cost-effectiveness. Results from this trial may help health care providers and policy makers to adapt and implement lifestyle interventions suitable for this population group that can be conducted in the community.Trial RegistrationNumber at NCT01420198.
    Trials 09/2013; 14(1):279. DOI:10.1186/1745-6215-14-279 · 1.73 Impact Factor
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    • "We based the direct medical costs for a true positive result (prediabetes110 or diabetes) on 3-year costs for the DPP metformin group. This group’s incremental costs for laboratory tests, physician visits, and follow-up were $703 (9). We assumed that all true-positive results would be treated with metformin, and we substituted recent pharmacy-based generic costs for metformin 850 mg twice per day. "
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    ABSTRACT: OBJECTIVE Although screening for diabetes and prediabetes is recommended, it is not clear how best or whom to screen. We therefore compared the economics of screening according to baseline risk. RESEARCH DESIGN AND METHODS Five screening tests were performed in 1,573 adults without known diabetes—random plasma/capillary glucose, plasma/capillary glucose 1 h after 50-g oral glucose (any time, without previous fast, plasma glucose 1 h after a 50-g oral glucose challenge [GCTpl]/capillary glucose 1 h after a 50-g oral glucose challenge [GCTcap]), and A1C—and a definitive 75-g oral glucose tolerance test. Costs of screening included the following: costs of testing (screen plus oral glucose tolerance test, if screen is positive); costs for false-negative results; and costs of treatment of true-positive results with metformin, all over the course of 3 years. We compared costs for no screening, screening everyone for diabetes or high-risk prediabetes, and screening those with risk factors based on age, BMI, blood pressure, waist circumference, lipids, or family history of diabetes. RESULTS Compared with no screening, cost-savings would be obtained largely from screening those at higher risk, including those with BMI >35 kg/m2, systolic blood pressure ≥130 mmHg, or age >55 years, with differences of up to −46% of health system costs for screening for diabetes and −21% for screening for dysglycemia110, respectively (all P < 0.01). GCTpl would be the least expensive screening test for most high-risk groups for this population over the course of 3 years. CONCLUSIONS From a health economics perspective, screening for diabetes and high-risk prediabetes should target patients at higher risk, particularly those with BMI >35 kg/m2, systolic blood pressure ≥130 mmHg, or age >55 years, for whom screening can be most cost-saving. GCTpl is generally the least expensive test in high-risk groups and should be considered for routine use as an opportunistic screen in these groups.
    Diabetes care 02/2013; 36(7). DOI:10.2337/dc12-1752 · 8.42 Impact Factor
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