Cost-effectiveness of lifestyle modification in diabetes patients

Jacobs-van der Bruggen, M. A. M., van Baal, P. H., Hoogenveen, R. T., Feenstra, T. L., Briggs, A. H. , Lawson, K., Feskens, E. J. M. and Baan, C. A. (2009) Cost-effectiveness of lifestyle modification in diabetes patients. Diabetes Care, 32(8), pp. 1453-1458. (doi: 10.2337/dc09-0363)

Abstract

<b>OBJECTIVE</b> To explore the potential long-term health and economic consequences of lifestyle interventions for diabetic patients.<p></p> <b>RESEARCH DESIGN AND METHODS</b> A literature search was performed to identify interventions for diabetic patients in which lifestyle issues were addressed. We selected recent (2003–2008), randomized controlled trials with a minimum follow-up of 12 months. The long-term outcomes for these interventions, if implemented in the Dutch diabetic population, were simulated with a computer-based model. Costs and effects were discounted at, respectively, 4 and 1.5% annually. A lifelong time horizon was applied. Probabilistic sensitivity analyses were performed, taking account of variability in intervention costs and (long-term) treatment effects.<p></p> <b>RESULTS</b> Seven trials with 147–5,145 participants met our predefined criteria. All interventions improved cardiovascular risk factors at ≥1 year follow-up and were projected to reduce cardiovascular morbidity over lifetime. The interventions resulted in an average gain of 0.01–0.14 quality-adjusted life-years (QALYs) per participant. Health benefits were generally achieved at reasonable costs (≤€50,000/QALY). A self-management education program (X-PERT) and physical activity counseling achieved the best results with ≥0.10 QALYs gained and ≥99% probability to be very cost-effective (≤€20,000/QALY).<p></p> <b>CONCLUSIONS</b> Implementation of lifestyle interventions would probably yield important health benefits at reasonable costs. However, essential evidence for long-term maintenance of health benefits was limited. Future research should be focused on long-term effectiveness and multiple treatment strategies should be compared to determine incremental costs and benefits of one over the other.<p></p>

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Briggs, Professor Andrew
• Authors: Jacobs-van der Bruggen, M. A. M., van Baal, P. H., Hoogenveen, R. T., Feenstra, T. L., Briggs, A. H., Lawson, K., Feskens, E. J. M., and Baan, C. A.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences
• Journal Name: Diabetes Care
• Publisher: American Diabetes Association
• ISSN: 0149-5992
• ISSN (Online): 1935-5548
• Published Online: 12 May 2009