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Lifestyle Interventions Are Cost-Effective in People With Different Levels of Diabetes Risk

Results from a modeling study

National Institute for Public Health and the Environment, Bilthoven, the Netherlands

Address correspondence and reprint requests to Monique A.M. Jacobs-van der Bruggen, National Institute for Public Health and the Environment, Department of Prevention and Health Services Research, P.O. Box 1, 3720 BA, Bilthoven, Netherlands. E-mail: monique.jacobs{at}rivm.nl

OBJECTIVE—In the current study we explore the long-term health benefits and cost-effectiveness of both a community-based lifestyle program for the general population (community intervention) and an intensive lifestyle intervention for obese adults, implemented in a health care setting (health care intervention).

RESEARCH DESIGN AND METHODS—Short-term intervention effects on BMI and physical activity were estimated from the international literature. The National Institute for Public Health and the Environment Chronic Diseases Model was used to project lifetime health effects and effects on health care costs for minimum and maximum estimates of short-term intervention effects. Cost-effectiveness was evaluated from a health care perspective and included intervention costs and related and unrelated medical costs. Effects and costs were discounted at 1.5 and 4.0% annually.

RESULTS—One new case of diabetes per 20 years was prevented for every 7–30 participants in the health care intervention and for every 300–1,500 adults in the community intervention. Intervention costs needed to prevent one new case of diabetes (per 20 years) were lower for the community intervention (2,000–9,000) than for the health care intervention (5,000–21,000). The cost-effectiveness ratios were 3,100–3,900 per quality-adjusted life-year (QALY) for the community intervention and 3,900–5,500 per QALY for the health care intervention.

CONCLUSIONS—Health care interventions for high-risk groups and community-based lifestyle interventions targeted to the general population (low risk) are both cost-effective ways of curbing the growing burden of diabetes.

Abbreviations: CDM, chronic diseases model • DPP, Diabetes Prevention Program • NNT, number needed to treat • QALY, quality-adjusted life-year • RIVM, National Institute for Public Health and the Environment

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