Cost-Effectiveness of Lifestyle Modification in Diabetic Patients
- Monique A.M. Jacobs-van der Bruggen, MSC1,
- Pieter H. van Baal, PHD1,
- Rudolf T. Hoogenveen, MSC1,
- Talitha L. Feenstra, PHD1,2,
- Andrew H. Briggs, DPHIL3,
- Kenny Lawson, MSC3,
- Edith J.M. Feskens, PHD4 and
- Caroline A. Baan, PHD1
- 1Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands;
- 2Department of Epidemiology, UMC Groningen, Groningen, the Netherlands;
- 3Section of Public Health and Health Policy, University of Glasgow, Glasgow, U.K.;
- 4Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands.
- Corresponding author: Monique Jacobs-van der Bruggen, monique.jacobs{at}rivm.nl.
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.
Footnotes
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received February 24, 2009.
- Accepted April 30, 2009.
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Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
- © 2009 by the American Diabetes Association.
