Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes
<strong>Objective:</strong> Diabetes is a global health priority, with high prevalence and substantial economic burden. Large trials have demonstrated the efficacy of lifestyle interventions and metformin in reducing subsequent incidence of diabetes. We evaluate the economic evidence...
| Main Authors: | , , , , , |
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| Format: | Journal article |
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BMJ Publishing Group
2017
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| _version_ | 1797080946665586688 |
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| author | Roberts, S Barry, E Craig, D Airoldi, M Bevan, G Greenhalgh, T |
| author_facet | Roberts, S Barry, E Craig, D Airoldi, M Bevan, G Greenhalgh, T |
| author_sort | Roberts, S |
| collection | OXFORD |
| description | <strong>Objective:</strong> Diabetes is a global health priority, with high prevalence and substantial economic burden. Large trials have demonstrated the efficacy of lifestyle interventions and metformin in reducing subsequent incidence of diabetes. We evaluate the economic evidence of these interventions alone and in combination with screening programmes, extracting key implications for policy makers and health insurers. <strong>Design:</strong> Systematic review <strong>Data sources and eligibility criteria:</strong> A database search (Embase, Medline, PreMedline, NHS EED) and citation tracking identified economic evaluations of lifestyle interventions or metformin alone or in combination with screening programmes in people at high risk of developing diabetes. Studies were evaluated using ISPOR’s Questionnaire to Assess Relevance and Credibility of Modelling Studies for Informing Healthcare Decision Making. <strong>Results:</strong> 2873 titles were scanned, 42 papers reviewed in full, with 27 papers included in the review, all of which evaluated lifestyle interventions and 12 of which also evaluated metformin. The majority (16 studies) identified pre-diabetes using the oral glucose tolerance test and the majority (17 studies) evaluated intensive-trial based lifestyle interventions. Lifestyle programmes and metformin appear to be cost-effective in preventing diabetes in high risk individuals (median ICERs of £7,490/QALY and £8,428/QALY respectively) but with a wide range of economic estimates observed between studies. Intervention-only programmes were in general more cost-effective than screening and intervention programmes and the longer the period evaluated, the more cost-effective interventions appeared. There is insufficient evidence to answer the question of 1) whether lifestyle programmes are more cost effective than metformin or 2) whether pragmatic lifestyle interventions are more cost-effective than intensive trial-based lifestyle programmes. <strong>Conclusions:</strong> National diabetes prevention policy in the UK and US advocates pragmatic lifestyle programmes (less than 3 years in duration), and in the UK the use of HbA1c or fasting plasma glucose is recommended for diagnosing pre-diabetes. However, the majority of cost-effectiveness studies relate to a different definition of pre-diabetes and a higher intensity of intervention, which limits the direct applicability of findings. In the few studies that evaluated other economic considerations, budget impact of prevention programs was moderate (0.13-0.2% of respective countries total healthcare budget), financial payoffs were delayed (net expenditure on treatment and prevention of diabetes declined after 9-14 years) and impact on incident cases of diabetes was limited (0.1-1.6% reduction). There remains a need for long-term economic evaluation of programmes that reflect current policy and consideration of the role of broader social and environmental programmes on diabetes incidence. |
| first_indexed | 2024-03-07T01:07:33Z |
| format | Journal article |
| id | oxford-uuid:8bdc37b8-42ed-4279-9245-fe2046a6609a |
| institution | University of Oxford |
| last_indexed | 2024-03-07T01:07:33Z |
| publishDate | 2017 |
| publisher | BMJ Publishing Group |
| record_format | dspace |
| spelling | oxford-uuid:8bdc37b8-42ed-4279-9245-fe2046a6609a2022-03-26T22:40:54ZPreventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetesJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:8bdc37b8-42ed-4279-9245-fe2046a6609aSymplectic Elements at OxfordBMJ Publishing Group2017Roberts, SBarry, ECraig, DAiroldi, MBevan, GGreenhalgh, T<strong>Objective:</strong> Diabetes is a global health priority, with high prevalence and substantial economic burden. Large trials have demonstrated the efficacy of lifestyle interventions and metformin in reducing subsequent incidence of diabetes. We evaluate the economic evidence of these interventions alone and in combination with screening programmes, extracting key implications for policy makers and health insurers. <strong>Design:</strong> Systematic review <strong>Data sources and eligibility criteria:</strong> A database search (Embase, Medline, PreMedline, NHS EED) and citation tracking identified economic evaluations of lifestyle interventions or metformin alone or in combination with screening programmes in people at high risk of developing diabetes. Studies were evaluated using ISPOR’s Questionnaire to Assess Relevance and Credibility of Modelling Studies for Informing Healthcare Decision Making. <strong>Results:</strong> 2873 titles were scanned, 42 papers reviewed in full, with 27 papers included in the review, all of which evaluated lifestyle interventions and 12 of which also evaluated metformin. The majority (16 studies) identified pre-diabetes using the oral glucose tolerance test and the majority (17 studies) evaluated intensive-trial based lifestyle interventions. Lifestyle programmes and metformin appear to be cost-effective in preventing diabetes in high risk individuals (median ICERs of £7,490/QALY and £8,428/QALY respectively) but with a wide range of economic estimates observed between studies. Intervention-only programmes were in general more cost-effective than screening and intervention programmes and the longer the period evaluated, the more cost-effective interventions appeared. There is insufficient evidence to answer the question of 1) whether lifestyle programmes are more cost effective than metformin or 2) whether pragmatic lifestyle interventions are more cost-effective than intensive trial-based lifestyle programmes. <strong>Conclusions:</strong> National diabetes prevention policy in the UK and US advocates pragmatic lifestyle programmes (less than 3 years in duration), and in the UK the use of HbA1c or fasting plasma glucose is recommended for diagnosing pre-diabetes. However, the majority of cost-effectiveness studies relate to a different definition of pre-diabetes and a higher intensity of intervention, which limits the direct applicability of findings. In the few studies that evaluated other economic considerations, budget impact of prevention programs was moderate (0.13-0.2% of respective countries total healthcare budget), financial payoffs were delayed (net expenditure on treatment and prevention of diabetes declined after 9-14 years) and impact on incident cases of diabetes was limited (0.1-1.6% reduction). There remains a need for long-term economic evaluation of programmes that reflect current policy and consideration of the role of broader social and environmental programmes on diabetes incidence. |
| spellingShingle | Roberts, S Barry, E Craig, D Airoldi, M Bevan, G Greenhalgh, T Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes |
| title | Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes |
| title_full | Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes |
| title_fullStr | Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes |
| title_full_unstemmed | Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes |
| title_short | Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes |
| title_sort | preventing type 2 diabetes systematic review of studies of cost effectiveness of lifestyle programmes and metformin with and without screening for pre diabetes |
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