The Cost-Effectiveness of Preventing Diabetes
- Steven Teutsch, MD, MPH
- From Merck and Co., Inc., West Point, Pennsylvania
- Address correspondence to Steven Teutsch, MD, MPH, Outcomes Research and Management, Merck and Co., Inc., P.O. Box 4, WP 39-168, West Point, PA 19486. E-mail: steven_teutsch{at}merck.com
There are many hurdles in the adoption of preventive programs. The first is efficacy, demonstrating that an intervention can work, at least in optimal settings. The breakthrough Diabetes Prevention Program (DPP) easily cleared this hurdle (1). The next step is to show that it is effective, proving that the results can be achieved in usual-care settings with their resource constraints and often broader cross section of patients. The final quantitative hurdle is cost-effectiveness, showing that the intervention is worth its cost (2).
The economic evaluation by the DPP Research Group (3) in this issue of Diabetes Care is an excellent example of a well-done, within-trial, cost-efficacy study. Building on the group’s earlier cost analysis (4), they use the numbers needed to treat (NNT) and utility analysis results from the trial to determine cost-effectiveness from societal and payer viewpoints. Within-trial analyses such as this one have several strengths. Costs and outcomes can be ascertained with a high degree of accuracy. Few assumptions and extrapolations are required. Yet within-trial analyses have limitations as well. Because of their limited time frames, important long-term costs and outcomes cannot be ascertained. We can only speculate about how well patients adhere to the regimens in the long term, whether the reductions in …
