Preventive Efforts in Type 2 Diabetes Are Cost Effective

Medscape Medical News from the:American Diabetes Association (ADA) 71st Scientific Session

Emma Hitt, PhD

June 29, 2011 (San Diego, California) — Preventive treatment with metformin or lifestyle intervention in patients with type 2 diabetes reduced the cost of medical care, including costs for inpatient and outpatient care and prescriptions, compared with placebo, according to data from a 10-year cost-effectiveness analysis from the Diabetes Prevention Program (DPP).

William H. Herman, MD, MPH, professor of medicine and epidemiology at the University of Michigan, Ann Arbor, and coinvestigator of the DPP Research Group, and colleagues presented the findings in the late-breaking session here at the American Diabetes Association (ADA) 71st Scientific Sessions.

In the DPP, overweight and obese participants with impaired glucose tolerance were randomly assigned to lifestyle intervention, metformin, or placebo.
Previous results, reported in 2002, indicated that lifestyle intervention led to a 58% reduction in the development of diabetes, from about 11% per year to about 5% per year.
By comparison, metformin resulted in a 31% reduction in the development of diabetes.

These findings indicate that treatment with metformin or lifestyle intervention reduced the cost of medical care by $1700 and $2600 per person, respectively, over 10 years, compared with placebo. However, lifestyle intervention cost more to administer than metformin or placebo, so when the reductions in the cost of medical care were balanced against the cost of the interventions, metformin saved $30 per person, whereas the lifestyle intervention cost $1500 per person over the 10-year period.

The lifestyle intervention aimed for a 7% reduction in body weight and the goal of 150 minutes per week of moderate-intensity activity. 
The lifestyle intervention was found to halve the number of people who progressed to diabetes, compared with the metformin intervention.
The lifestyle intervention also improved quality of life, compared with metformin or placebo.
When cost of care and measures of health and quality of life were considered simultaneously, both interventions were found to be highly cost effective.
These study findings put "diabetes prevention in the category of prenatal care or pediatric immunizations," noted Dr. Herman in an ADA release. "It's dramatic when an intervention can improve the health of the population and potentially save money at the same time," he added.

"The DPP has shown that lifestyle intervention and metformin can decrease the epidemic of diabetes that is currently affecting the United States and much of the world and, in doing so, may save money," noted David M. Nathan, MD, DPP chair and professor of medicine at Harvard Medical School, Boston, Massachusetts. "The cost savings may seem modest now, but any decrease in medical costs is welcome, and the savings may very well increase in the future."
According to the researchers, healthcare and societal policies should support the use of lifestyle intervention and metformin to prevent or delay diabetes.
The study was not commercially funded. Dr. Herman and Dr. Nathan have disclosed no relevant financial relationships.
American Diabetes Association (ADA) 71st Scientific Sessions: Abstract 0136-LBOR. Presented June 28, 2011.