Assessing the cost-effectiveness of drug and lifestyle intervention following opportunistic screening for pre-diabetes in primary care

Bertram, M. Y., Lim, S. S., Barendregt, J. J. and Vos, T. (2010) Assessing the cost-effectiveness of drug and lifestyle intervention following opportunistic screening for pre-diabetes in primary care. Diabetologia, 53 5: 875-881. doi:10.1007/s00125-010-1661-8

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Author Bertram, M. Y.
Lim, S. S.
Barendregt, J. J.
Vos, T.
Title Assessing the cost-effectiveness of drug and lifestyle intervention following opportunistic screening for pre-diabetes in primary care
Journal name Diabetologia   Check publisher's open access policy
ISSN 0012-186X
1432-0428
Publication date 2010-05
Sub-type Article (original research)
DOI 10.1007/s00125-010-1661-8
Volume 53
Issue 5
Start page 875
End page 881
Total pages 7
Editor Edwin A.M. Gale
Place of publication Berlin, Germany
Publisher Springer-Verlag
Collection year 2011
Language eng
Formatted abstract
Aims/hypothesis This study aims to evaluate the cost-effectiveness of a screening programme for pre-diabetes, which was followed up by treatment with pharmaceutical interventions (acarbose, metformin, orlistat) or lifestyle interventions (diet, exercise, diet and exercise) in order to prevent or slow the onset of diabetes in those at high risk.

Methods To approximate the experience of individuals with pre-diabetes in the Australian population, we used a microsimulation approach, following patient progression through diabetes, cardiovascular disease and renal failure. The model compares costs and disability-adjusted life years lived in people identified through an opportunistic screening programme for each intervention compared with a ‘do nothing’ scenario, which is representative of current practice. It is assumed that the effect of a lifestyle change will decay by 10% per year, while the effect of a pharmaceutical intervention remains constant throughout use.

Results The most cost-effective intervention options are diet and exercise combined, with a cost-effectiveness ratio of AUD 22,500 per disability-adjusted life year (DALY) averted, and metformin with a cost-effectiveness ratio of AUD 21,500 per DALY averted. The incremental addition of one intervention to the other is not cost-effective.

Conclusions/interpretation Screening for pre-diabetes followed by diet and exercise, or metformin treatment is cost-effective and should be considered for incorporation into current practice. The number of dietitians and exercise physiologists needed to deliver such lifestyle change interventions will need to be increased to appropriately support the intervention.
© 2010 Springer-Verlag.
Keyword Cost-effectiveness
Economic evaluation
Pre-diabetes
Screening
Impaired glucose-tolerance
Melbourne stroke incidence
Diabetes prevention
Australia
Population
Strategies
Metformin
Subtypes
Acarbose
Insulin
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Electronic supplementary material: The online version of this article contains supplementary material

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Public Health Publications
 
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Created: Sun, 25 Apr 2010, 00:05:29 EST