Cost-effectiveness of Diabetes Prevention Interventions Targeting High-risk Individuals and Whole Populations: A Systematic Review
We conducted a systematic review of studies evaluating the cost-effectiveness (CE) of interventions to prevent type 2 diabetes (T2D) among high-risk individuals and whole populations. Interventions targeting high-risk individuals are those that identify people at high risk of developing T2D and then...
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| Vydáno v: | Diabetes care Ročník 43; číslo 7; s. 1593 |
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| Médium: | Journal Article |
| Jazyk: | angličtina |
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01.07.2020
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| ISSN: | 1935-5548, 1935-5548 |
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| Abstract | We conducted a systematic review of studies evaluating the cost-effectiveness (CE) of interventions to prevent type 2 diabetes (T2D) among high-risk individuals and whole populations.
Interventions targeting high-risk individuals are those that identify people at high risk of developing T2D and then treat them with either lifestyle or metformin interventions. Population-based prevention strategies are those that focus on the whole population regardless of the level of risk, creating public health impact through policy implementation, campaigns, and other environmental strategies. We systematically searched seven electronic databases for studies published in English between 2008 and 2017. We grouped lifestyle interventions targeting high-risk individuals by delivery method and personnel type. We used the median incremental cost-effectiveness ratio (ICER), measured in cost per quality-adjusted life year (QALY) or cost saved to measure the CE of interventions. We used the $50,000/QALY threshold to determine whether an intervention was cost-effective or not. ICERs are reported in 2017 U.S. dollars.
Our review included 39 studies: 28 on interventions targeting high-risk individuals and 11 targeting whole populations. Both lifestyle and metformin interventions in high-risk individuals were cost-effective from a health care system or a societal perspective, with median ICERs of $12,510/QALY and $17,089/QALY, respectively, compared with no intervention. Among lifestyle interventions, those that followed a Diabetes Prevention Program (DPP) curriculum had a median ICER of $6,212/QALY, while those that did not follow a DPP curriculum had a median ICER of $13,228/QALY. Compared with lifestyle interventions delivered one-on-one or by a health professional, those offered in a group setting or provided by a combination of health professionals and lay health workers had lower ICERs. Among population-based interventions, taxing sugar-sweetened beverages was cost-saving from both the health care system and governmental perspectives. Evaluations of other population-based interventions-including fruit and vegetable subsidies, community-based education programs, and modifications to the built environment-showed inconsistent results.
Most of the T2D prevention interventions included in our review were found to be either cost-effective or cost-saving. Our findings may help decision makers set priorities and allocate resources for T2D prevention in real-world settings. |
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| AbstractList | We conducted a systematic review of studies evaluating the cost-effectiveness (CE) of interventions to prevent type 2 diabetes (T2D) among high-risk individuals and whole populations.OBJECTIVEWe conducted a systematic review of studies evaluating the cost-effectiveness (CE) of interventions to prevent type 2 diabetes (T2D) among high-risk individuals and whole populations.Interventions targeting high-risk individuals are those that identify people at high risk of developing T2D and then treat them with either lifestyle or metformin interventions. Population-based prevention strategies are those that focus on the whole population regardless of the level of risk, creating public health impact through policy implementation, campaigns, and other environmental strategies. We systematically searched seven electronic databases for studies published in English between 2008 and 2017. We grouped lifestyle interventions targeting high-risk individuals by delivery method and personnel type. We used the median incremental cost-effectiveness ratio (ICER), measured in cost per quality-adjusted life year (QALY) or cost saved to measure the CE of interventions. We used the $50,000/QALY threshold to determine whether an intervention was cost-effective or not. ICERs are reported in 2017 U.S. dollars.RESEARCH DESIGN AND METHODSInterventions targeting high-risk individuals are those that identify people at high risk of developing T2D and then treat them with either lifestyle or metformin interventions. Population-based prevention strategies are those that focus on the whole population regardless of the level of risk, creating public health impact through policy implementation, campaigns, and other environmental strategies. We systematically searched seven electronic databases for studies published in English between 2008 and 2017. We grouped lifestyle interventions targeting high-risk individuals by delivery method and personnel type. We used the median incremental cost-effectiveness ratio (ICER), measured in cost per quality-adjusted life year (QALY) or cost saved to measure the CE of interventions. We used the $50,000/QALY threshold to determine whether an intervention was cost-effective or not. ICERs are reported in 2017 U.S. dollars.Our review included 39 studies: 28 on interventions targeting high-risk individuals and 11 targeting whole populations. Both lifestyle and metformin interventions in high-risk individuals were cost-effective from a health care system or a societal perspective, with median ICERs of $12,510/QALY and $17,089/QALY, respectively, compared with no intervention. Among lifestyle interventions, those that followed a Diabetes Prevention Program (DPP) curriculum had a median ICER of $6,212/QALY, while those that did not follow a DPP curriculum had a median ICER of $13,228/QALY. Compared with lifestyle interventions delivered one-on-one or by a health professional, those offered in a group setting or provided by a combination of health professionals and lay health workers had lower ICERs. Among population-based interventions, taxing sugar-sweetened beverages was cost-saving from both the health care system and governmental perspectives. Evaluations of other population-based interventions-including fruit and vegetable subsidies, community-based education programs, and modifications to the built environment-showed inconsistent results.RESULTSOur review included 39 studies: 28 on interventions targeting high-risk individuals and 11 targeting whole populations. Both lifestyle and metformin interventions in high-risk individuals were cost-effective from a health care system or a societal perspective, with median ICERs of $12,510/QALY and $17,089/QALY, respectively, compared with no intervention. Among lifestyle interventions, those that followed a Diabetes Prevention Program (DPP) curriculum had a median ICER of $6,212/QALY, while those that did not follow a DPP curriculum had a median ICER of $13,228/QALY. Compared with lifestyle interventions delivered one-on-one or by a health professional, those offered in a group setting or provided by a combination of health professionals and lay health workers had lower ICERs. Among population-based interventions, taxing sugar-sweetened beverages was cost-saving from both the health care system and governmental perspectives. Evaluations of other population-based interventions-including fruit and vegetable subsidies, community-based education programs, and modifications to the built environment-showed inconsistent results.Most of the T2D prevention interventions included in our review were found to be either cost-effective or cost-saving. Our findings may help decision makers set priorities and allocate resources for T2D prevention in real-world settings.CONCLUSIONSMost of the T2D prevention interventions included in our review were found to be either cost-effective or cost-saving. Our findings may help decision makers set priorities and allocate resources for T2D prevention in real-world settings. We conducted a systematic review of studies evaluating the cost-effectiveness (CE) of interventions to prevent type 2 diabetes (T2D) among high-risk individuals and whole populations. Interventions targeting high-risk individuals are those that identify people at high risk of developing T2D and then treat them with either lifestyle or metformin interventions. Population-based prevention strategies are those that focus on the whole population regardless of the level of risk, creating public health impact through policy implementation, campaigns, and other environmental strategies. We systematically searched seven electronic databases for studies published in English between 2008 and 2017. We grouped lifestyle interventions targeting high-risk individuals by delivery method and personnel type. We used the median incremental cost-effectiveness ratio (ICER), measured in cost per quality-adjusted life year (QALY) or cost saved to measure the CE of interventions. We used the $50,000/QALY threshold to determine whether an intervention was cost-effective or not. ICERs are reported in 2017 U.S. dollars. Our review included 39 studies: 28 on interventions targeting high-risk individuals and 11 targeting whole populations. Both lifestyle and metformin interventions in high-risk individuals were cost-effective from a health care system or a societal perspective, with median ICERs of $12,510/QALY and $17,089/QALY, respectively, compared with no intervention. Among lifestyle interventions, those that followed a Diabetes Prevention Program (DPP) curriculum had a median ICER of $6,212/QALY, while those that did not follow a DPP curriculum had a median ICER of $13,228/QALY. Compared with lifestyle interventions delivered one-on-one or by a health professional, those offered in a group setting or provided by a combination of health professionals and lay health workers had lower ICERs. Among population-based interventions, taxing sugar-sweetened beverages was cost-saving from both the health care system and governmental perspectives. Evaluations of other population-based interventions-including fruit and vegetable subsidies, community-based education programs, and modifications to the built environment-showed inconsistent results. Most of the T2D prevention interventions included in our review were found to be either cost-effective or cost-saving. Our findings may help decision makers set priorities and allocate resources for T2D prevention in real-world settings. |
| Author | Siegel, Karen R Zhou, Xilin Albright, Ann L Jawanda, Shawn Ng, Boon Peng Proia, Krista K Zhang, Xuanping Zhang, Ping |
| Author_xml | – sequence: 1 givenname: Xilin orcidid: 0000-0003-3131-5948 surname: Zhou fullname: Zhou, Xilin organization: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA – sequence: 2 givenname: Karen R orcidid: 0000-0002-6967-9088 surname: Siegel fullname: Siegel, Karen R organization: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA – sequence: 3 givenname: Boon Peng orcidid: 0000-0001-6070-661X surname: Ng fullname: Ng, Boon Peng organization: College of Nursing and Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL – sequence: 4 givenname: Shawn surname: Jawanda fullname: Jawanda, Shawn organization: Oak Ridge Institute for Science and Education, Oak Ridge, TN – sequence: 5 givenname: Krista K surname: Proia fullname: Proia, Krista K organization: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA – sequence: 6 givenname: Xuanping surname: Zhang fullname: Zhang, Xuanping email: paz2@cdc.gov organization: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA paz2@cdc.gov – sequence: 7 givenname: Ann L surname: Albright fullname: Albright, Ann L organization: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA – sequence: 8 givenname: Ping orcidid: 0000-0001-8429-6301 surname: Zhang fullname: Zhang, Ping email: paz2@cdc.gov organization: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA paz2@cdc.gov |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33534726$$D View this record in MEDLINE/PubMed |
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| SubjectTerms | Adult Aged Community Networks - economics Community Networks - organization & administration Community Networks - statistics & numerical data Cost-Benefit Analysis Diabetes Mellitus, Type 2 - economics Diabetes Mellitus, Type 2 - epidemiology Diabetes Mellitus, Type 2 - prevention & control Endocrinology - economics Endocrinology - methods Endocrinology - trends Health Care Costs Health Expenditures - statistics & numerical data Health Promotion - economics Health Promotion - methods Health Promotion - statistics & numerical data Humans Life Style Metformin - therapeutic use Middle Aged Patient Education as Topic - economics Patient Education as Topic - organization & administration Patient Education as Topic - statistics & numerical data Population Surveillance - methods Prediabetic State - economics Prediabetic State - epidemiology Prediabetic State - therapy Preventive Medicine - economics Preventive Medicine - methods Quality-Adjusted Life Years Risk Factors Risk Reduction Behavior Young Adult |
| Title | Cost-effectiveness of Diabetes Prevention Interventions Targeting High-risk Individuals and Whole Populations: A Systematic Review |
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