Cost-effectiveness of lifestyle modification in diabetic patients

M.A. Jacobs-Van der Bruggen, P.H. van Baal, R.T. Hoogenveen, T.L. Feenstra, A.H. Briggs, K. Lawson, E.J.M. Feskens, C.A. Baan

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Abstract

OBJECTIVE To explore the potential long-term health and economic consequences of lifestyle interventions for diabetic patients. RESEARCH DESIGN AND METHODS 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. RESULTS 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). CONCLUSIONS 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.
Original languageEnglish
Pages (from-to)1453-1458
JournalDiabetes Care
Volume32
Issue number8
DOIs
Publication statusPublished - 2009

Keywords

  • physical-activity
  • self-management
  • behavior-change
  • interventions
  • program
  • weight
  • trial
  • maintenance
  • prevention
  • education

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