Costs Associated With the Primary Prevention of Type 2 Diabetes Mellitus in the Diabetes Prevention Program
Article Figures & Tables
Tables
- Table A1—
Unit costs used for calculating costs of DPP by type of cost
Items Unit Cost (median/mean, $) Sources Direct medical costs DPP personnel LCM 1 h 23.55 DPP MCM 1 h 25.24 DPP Exercise trainer 1 h 26.02 DPP Dietitian 1 h 26.21 DPP Medical assistant 1 h 18.14 DPP Secretary 1 h 19.54 DPP Materials Educational and training material Lifestyle 1 set 8.85 DPP Metformin 1 set 0.08 DPP Placebo 1 set 2.26 DPP Lab tests and procedures OGTT 1 17.22 9 Exercise tests (CVD stress) 1 114.00 9 Venipuncture 1 3.00 9 Serum creatinine 1 6.84 9 Urine creatinine 1 6.92 9 Hemoglobin/hematocrit 1 7.91 9 Medication Metformin 1 tablet 1.10 10 Prescription medications 1 year/person 407.00 11 Bundled medical services Hospital days* 1 2,353.00 12,13 Emergency room visits† 1 167.00 13 Urgent care visits 1 91.00 13 Outpatient visits 1 51.00 13 Calls to providers 1 20.00 13 Direct nonmedical costs Participant time Travel time 1 h 8.00 14 People who dislike exercise 1 h 8.00 14 People who are neutral about exercise 1 h 4.00 14 Shopping and cooking 1 h 4.00 14 Services Exercise classes 1 week 16.60 15 Health club 3 years 2,305.00 16 Personal trainer 1 h 34.00 17 Commercial weight loss classes 1 month 46.00 16 Fitness equipment Exercise shoes 1 pair 73.27 16 Bicycle 1 430.40 16 Exercise videos 1 15.02 16 Free weights 2 39.06 18 Golf clubs 1 set 390.61 18 Home gym 1 683.57 16 Stationary bicycle 1 548.80 16 Step 1 system 78.12 18 Treadmill 1 1,100.00 16 Food equipment Air popper 1 25.39 19 Blender 1 39.70 16 Cookbooks 1 25.39 20 Food scale 1 24.41 21 Freezer 1 449.54 16 Microwave 1 155.04 16 Mixer 1 132.46 16 Steamer 1 31.01 16 Wok 1 set 206.10 16 Food costs Food at home 1 year 1,633.00 22 Food away from home 1 year 1,430.00 22 Transportation costs 1 mile 0.35 23 Indirect costs Time lost from doing usual activity due to morbidity or mortality 1 day 108.00 14 - *
↵* Cost of a hospital day based on facility charge of $2,242 (Health Care Utilization Project) and a physician fee of $111.
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↵† Cost of an emergency room visit based on the facility charge of $102 (Health Care Financing Administration, personal communication with Mr. Jerry Riley) and a physician fee of $51 (HealthCare Consultants of America). LCM, Lifestyle Case Manager; MCM, Medication Case Manager.
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- Table 1—
Per capita direct medical costs of the placebo intervention by year
Item Provider Units Subjects (%) Time (h) Unit cost ($) Total cost ($) Year 1 1st visit counseling MCM 1 100 0.50 25.24 13 1st visit materials On Your Way to Fitness 1 100 1.00 1 Dietary Guidelines for Americans 1 75 1.16 1 3-month visit counseling MCM 1 100 0.25 25.24 6 3-month visit diet Dietitian 1 12 0.63 26.12 2 Phone calls MCM 1 10 0.16 25.24 0 Reminder phone calls Secretary 2 100 0.08 19.54 3 Overhead (69% of personnel) 17 Total cost (year 1) 43 Year 2 Annual visit MCM 1 100 0.33 25.24 8 Phone calls MCM 1 10 0.16 25.24 0 Reminder phone calls Secretary 1 100 0.08 19.54 2 Overhead (69% of personnel) 7 Total cost (year 2) 18 Year 3 Annual visit MCM 1 100 0.33 25.24 8 Phone calls MCM 1 10 0.16 25.24 0 Reminder phone calls Secretary 1 100 0.08 19.54 2 Overhead (69% of personnel) 7 Total cost (year 3) 18 Total cost (years 1–3) 79 -
MCM, Medication Case Manager.
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- Table 2—
Per capita direct medical costs of the metformin intervention by year
Item Provider Units Subjects (%) Time (h) Unit cost ($) Total cost ($) Year 1 Standard lifestyle recommendation (see Table 1 year 1 for details) 43 Baseline history and physical exam Physician 1 100 91.00 91 Baseline labs Venipuncture 1 100 3.00 3 Serum creatinine 1 100 6.84 7 Hemoglobin/hematocrit 1 100 7.91 8 Urine creatinine 1 0.3 6.92 0 Metformin fact-sheet 1 100 0.08 0 Metformin 0 tablet dose 0 9 1.10 0 1 tablet dose 365 15 1.10 60 2 tablet dose 730 76 1.10 610 Follow-up visits MCM 3.46 100 0.33 25.24 29 MA 3.46 62 0.33 18.14 13 Dose-titration/restart visits MCM 1.39 100 0.33 25.24 12 Outbound phone calls MCM 3 25 0.16 25.24 3 Inbound phone calls MCM 2 30 0.16 25.24 3 Reminder phone calls Secretary 5.85 100 0.08 19.54 10 Tool box 17 Overhead (69% of personnel) 110 Total cost (year 1) 1,019 Year 2 Standard lifestyle recommendation (see Table 1 year 2 for details) 18 Lab monitoring Venipuncture 1 84 3.00 3 Serum creatinine 1 84 6.84 6 Hemoglobin/hematocrit 1 84 7.91 7 Urine creatinine 1 0.4 6.92 0 Metformin 0 tablet dose 0 16 1.10 0 1 tablet dose 365 14 1.10 56 2 tablet dose 730 70 1.10 562 Follow-up visits MCM 3.97 100 0.33 25.24 33 MA 3.97 62 0.33 18.14 15 Dose-titration/restart visits MCM 0.07 100 0.33 25.24 1 Outbound phone calls MCM 3 25 0.16 25.24 3 Inbound phone calls MCM 2 30 0.16 25.24 3 Reminder phone calls Secretary 4.04 100 0.08 19.54 7 Tool box 17 Overhead (69% of personnel) 42 Total cost (year 2) 772 Year 3 Standard lifestyle recommendation (see Table year 3 for details) 18 Lab monitoring Venipuncture 1 80 3.00 2 Serum creatinine 1 80 6.84 5 Hemoglobin/hematocrit 1 80 7.91 6 Urine creatinine 1 0.4 6.92 0 Metformin 0 tablet dose 0 20 1.10 0 1 tablet dose 365 12 1.10 48 2 tablet dose 730 68 1.10 546 Follow-up visits MCM 3.97 100 0.33 25.24 33 MA 3.97 62 0.33 18.14 15 Dose-titration/restart visits MCM 0.07 100 0.33 25.24 1 Outbound phone calls MCM 3 25 0.16 25.24 3 Inbound phone calls MCM 2 30 0.16 25.24 3 Reminder phone calls Secretary 4.04 100 0.08 19.54 7 Tool box 22 Overhead (69% of personnel) 42 Total cost (year 3) 751 Total cost (years 1–3) 2,542 -
MA, Medical Assistant; MCM, Medication Case Manager.
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- Table 3—
Per capita direct medical costs of the lifestyle intervention by year
Item Provider Units Subjects (%) Time (h) Unit cost ($) Total cost ($) Year 1 Baseline history and physical exam Physician 1 100 91.00 91 Exercise test 1 19 114.00 22 Core curriculum LCM 16 100 1.00 23.55 377 Materials 1 100 8.85 9 Supervised activity sessions LCM 4.27 60 1.00 23.55 60 Trainer 4.27 40 1.00 26.02 44 Lifestyle group sessions LCM 0.36 100 1.25 23.55 11 In-person visits LCM 7.65 100 0.58 23.55 105 Phone calls LCM 2.32 100 0.25 23.55 14 Reminder phone calls Secretary 29.41 100 0.08 19.54 48 Tool box 102 Overhead (69% of personnel) 517 Total cost (year 1) 1,399 Year 2 Supervised activity sessions LCM 4.27 60 1.00 23.55 60 Trainer 4.27 40 1.00 26.02 44 Lifestyle group sessions LCM 0.72 100 1.25 23.55 21 In-person visits LCM 12.33 100 0.58 23.55 169 Phone calls LCM 2.66 100 0.25 23.55 16 Reminder phone calls Secretary 17.45 100 0.08 19.54 28 Tool box 105 Overhead (69% of personnel) 234 Total cost (year 2) 679 Year 3 Supervised activity sessions LCM 4.27 60 1.00 23.55 60 Trainer 4.27 40 1.00 26.02 44 Lifestyle group sessions LCM 0.72 100 1.25 23.55 21 In-person visits LCM 12.33 100 0.58 23.55 169 Phone calls LCM 2.66 100 0.25 23.55 16 Reminder phone calls Secretary 17.45 100 0.08 19.54 28 Tool box 128 Overhead (69% of personnel) 234 Total cost (year 3) 702 Total cost (Years 1–3) 2,780 -
LCM, Lifestyle Case Manager.
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- Table 4—
Per capita direct medical costs of care outside the DPP by intervention group, years 1–3
Placebo Placebo costs Metformin Metformin costs Lifestyle Lifestyle costs Metformin vs. placebo ($) Lifestyle vs. placebo ($) Hospital days 0.81 1,906 0.72 1,694 0.72 1,694 −212 −212 Emergency room visits 0.66 110 0.65 109 0.74 124 −2 13 Urgent care visits 1.38 126 1.32 120 1.21 110 −5 −15 Outpatient visits 12.94 660 13.26 676 11.63 593 16 −67 Calls to providers 10.34 207 11.16 223 10.08 202 16 −5 Prescription medications 4.92 2,002 4.71 1,917 4.55 1,856 −85 −147 Total (years 1–3) 5,011 4,739 4,579 −272 −432 - Table 5—
Per capita direct nonmedical costs by intervention group, years 1–3
Placebo Placebo costs ($) Metformin Metformin costs ($) Lifestyle Lifestyle costs ($) Metformin vs. placebo ($) Lifestyle vs. placebo ($) Participant time Visits 24.17 h 193 39.62 h 317 135.67 h 1,085 124 892 Adjusted exercise* 163.35 h 728 164.83 h 731 150.80 h 704 3 −24 Shopping and cooking 1120.58 h 4,482 1075.74 h 4,303 1062.78 h 4,251 −179 −231 Total 5,404 5,350 6,040 −52 637 Services Exercise classes 16% 207 14% 181 21% 272 −25 65 Health club 19% 219 19% 218 27% 311 −1 92 Personal trainer 4% 7 4% 7 5% 8 0 2 Commercial weight loss classes 12% 99 13% 107 6% 50 8 −49 Total 532 514 642 −18 110 Fitness equipment Bicycle† 13% 28 11% 24 17% 37 −4 9 Exercise videos 29% 4 25% 4 37% 6 0 1 Free weights 24% 9 21% 8 35% 14 −1 4 Golf clubs† 5% 10 4% 8 5% 10 −2 0 Home gym† 5% 17 4% 14 5% 17 −3 0 Stationary bicycle† 10% 28 10% 27 13% 36 0 8 Step 4% 3 4% 3 7% 5 0 2 Treadmill† 12% 66 11% 61 18% 99 −5 33 Total 165 148 223 −17 58 Food equipment Air popper 7% 2 4% 1 9% 2 −1 1 Blender 21% 8 21% 8 21% 8 0 0 Cookbooks 42% 11 42% 11 51% 13 0 2 Food scale 11% 3 12% 3 26% 6 0 4 Freezer† 7% 16 7% 16 7% 16 0 0 Microwave† 15% 12 15% 12 15% 12 0 0 Mixer† 11% 7 10% 7 8% 5 −1 −2 Steamer 14% 4 15% 5 21% 7 0 2 Wok† 8% 8 8% 8 10% 10 0 2 Total 71 70 79 −1 9 Shoes 3 pairs 220 3 pairs 220 6 pairs 439 0 220 Food costs Food at home 4,995 4,987 5,002 −7 7 Food away from home 4,229 4,239 4,150 10 −79 Total 9,223 9,226 9,152 3 −71 Transportation costs 224.4 miles 79 440.6 miles 154 1606.2 miles 562 76 484 Grand total 15,692 15,683 17,137 −9 1,445 - *
↵* Leisure-time physical activity was valued according to whether participants “disliked,” were “neutral,” or “liked” leisure-time physical activity.
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↵† We assumed that durable equipment initially valued at >$100 (see appendix) retained 50% of its original purchase price after 3 years. Percent value stated in rounded numbers.
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- Table 6—
Indirect costs by intervention group, years 1–3
Placebo (days) Placebo costs ($) Metformin (days) Metformin costs ($) Lifestyle (days) Lifestyle costs ($) Metformin vs. placebo ($) Lifestyle vs. placebo ($) Morbidity 21.31 2,301 23.31 2,517 21.23 2,293 216 −1 Mortality 2.80 302 2.93 316 1.27 137 14 −165 Total 2,604 2,834 2,430 230 −174 - Table 7—
Per capita differences in costs of the metformin and lifestyle interventions relative to the placebo intervention (year 2000, U.S. dollars) over 3 years in DPP
Metformin vs. placebo ($) Lifestyle vs. placebo ($) Direct medical costs Intervention 2,463 2,701 Care outside DPP −272 −432 Total 2,191 2,269 Direct nonmedical costs −9 1,445 Indirect costs 230 −174 Total cost Health system perspective 2,191 2,269 Societal perspective 2,412 3,540
In this Issue
January 2003, 26(1)
Costs Associated With the Primary Prevention of Type 2 Diabetes Mellitus in the Diabetes Prevention Program
