Abstract

Objective - To explore the potential long-term health and economic consequences of lifestyle interventions for diabetes patients.

Research Design and Methods - A literature search was performed to identify interventions for diabetes 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 diabetes population, were simulated with a computer-based model. Costs and effects were discounted at respectively 4% and 1.5% annually. A life-long time horizon was applied. Probabilistic sensitivity analyses were carried out, taking account of variability in intervention costs and (long-term) treatment effects.

Results - Seven trials with 147 to 5145 participants, met our pre-defined criteria. All interventions improved cardiovascular risk factors at ≥ one year follow-up and were projected to reduce cardiovascular morbidity over lifetime. The interventions resulted in an average gain of 0.01 to 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 focus on long-term effectiveness and should compare multiple treatment strategies to determine incremental costs and benefits of one over the other.