Within-Trial Cost-Effectiveness of Lifestyle Intervention or Metformin for the Primary Prevention of Type 2 Diabetes

Epidemiology/Health Services/Psychosocial Research

From the Diabetes Prevention Program Coordinating Center, Biostatistics Center, Rockville, Maryland

Address correspondence and reprint requests to the Diabetes Prevention Program Group, Diabetes Prevention Program Coordinating Center, George Washington University Biostatistics Center, 6110 Executive Blvd., Suite 750, Rockville, MD 20852. E-mail: dppmail{at}biostat.bsc.gwu.edu

Diabetes Care 2003 Sep; 26(9): 2518-2523. https://doi.org/10.2337/diacare.26.9.2518

Article Figures & Tables

Table 1—

Summary of total and incremental costs of the lifestyle, metformin, and placebo interventions in year-2000 U.S. dollars

	Lifestyle	Metformin	Placebo	Lifestyle vs. placebo	Metformin vs. placebo	Lifestyle vs. metformin
Direct medical costs
Case finding	139	139	139	0	0	0
Intervention	2,780	2,542	79	2,701	2,463	238
Care outside DPP	4,579	4,739	5,011	−432	−272	−160
Total costs from health system perspective	7,498	7,420	5,229	2,269	2,191	78
Direct nonmedical costs	17,137	15,683	15,692	1,445	−9	1,455
Indirect costs	2,430	2,834	2,604	−174	230	−404
Total costs from societal perspective	27,065	25,937	23,525	3,540	2,412	1,128

Table 2—

Health utility scores and QALYs gained by treatment group and year

Table 3—

Cost of DPP interventions over 3 years per case of diabetes prevented during the trial and per QALY gained

	Cost per case of diabetes prevented (U.S. $)			Cost per QALY gained (U.S. $)
		Health system perspective	Societal perspective	Health system perspective	Societal perspective
Lifestyle
Comparator
Lifestyle vs. placebo	15,655	24,426	31,512	51,582
Lifestyle vs. nothing	17,161	25,932	34,543	54,613
Personnel cost
25% reduction	11,755	20,526	23,662	43,732
50% reduction	7,855	16,626	15,811	35,880
75% reduction	3,956	12,727	7,963	28,033
Intervention effectiveness
10% reduction	17,243	26,904	35,013	57,313
20% reduction	18,831	29,382	39,389	64,477
Translated as group intervention	4,462	13,233	8,982	29,052
Discounting
3% discount rate (costs and outcomes)	15,804	24,581	32,029	52,250
Metformin
Comparator
Metformin vs. placebo	31,338	34,489	99,611	99,171
Metformin vs. nothing	34,458	37,609	109,531	109,090
Metformin cost
25% reduction	24,606	27,757	78,212	77,772
50% reduction	17,874	21,025	56,814	56,373
75% reduction	11,141	14,292	35,415	34,974
Intervention effectiveness
10% reduction	34,406	37,865	110,679	110,190
20% reduction	37,693	41,483	124,514	123,964
Discounting
3% discount rate (costs and outcomes)	31,452	34,604	102,164	101,713