Issue 119 Item 5 Interventions for Preventing Diabetes

It Costs 26,000 Dollars to Prevent a Case of Type 2 Diabetes, While Saving 150,000 Dollars.

The intensive interventions used in the Diabetes Prevention Program are likely to be affordable in the real world—especially if lifestyle counseling is done in group sessions and generic metformin is used, Dr. William H. Herman said at the annual scientific sessions of the American Diabetes Association in San Francisco.

In the multicenter, National Institutes of Health–funded study of 3,234 adults with impaired glucose tolerance, twice-daily 850-mg dosages of metformin plus standard lifestyle recommendations reduced the risk of developing diabetes by 31% over a 3-year period, compared with placebo plus standard lifestyle recommendations. But intensive diet and exercise intervention decreased the diabetes rate by 58%.

The intensive lifestyle intervention included a 6-month, 16-session curriculum, plus monthly sessions thereafter. Sessions covered diet, exercise, and behavior modification, all aimed at getting patients to exercise at least 150 minutes a week and lose 7% or more of their initial body weight, said Dr. Herman, interim director of the Michigan Diabetes Research and Training Center at the University of Michigan Health System.

Speaking on behalf of the Rockville, Md.–based Diabetes Prevention Program (DPP) Research Group, Dr. Herman presented cost analyses from two perspectives: The health system perspective includes only direct medical costs; the societal perspective also factors in direct nonmedical costs such as transportation and exercise classes, and indirect costs such as work absence due to illness.

Overall, intensive lifestyle intervention and metformin therapy cost about $2,600 more per participant over 3 years. The cost per case prevented by metformin was higher than that for lifestyle change because the drug was less effective in preventing diabetes. (See table.)

“The general feeling is that if the cost of an intervention is less than $100,000 per [quality-adjusted life-year] gained, it represents a good value to society.” Generic metformin (75% lower cost than brand-name) and lifestyle counseling in groups of 10 patients both are “a good value for the money,” Dr. Herman said.