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Cost Effectiveness and Resource Allocation

, 9:17

First Online: 18 November 2011Received: 25 October 2010Accepted: 18 November 2011


BackgroundType 2 diabetes mellitus T2D poses a large worldwide burden for health care systems. One possible tool to decrease this burden is primary prevention. As it is unethical to wait until perfect data are available to conclude whether T2D primary prevention intervention programmes are cost-effective, we need a model that simulates the effect of prevention initiatives. Thus, the aim of this study is to investigate the long-term cost-effectiveness of lifestyle intervention programmes for the prevention of T2D using a Markov model. As decision makers often face difficulties in applying health economic results, we visualise our results with health economic tools.

MethodsWe use four-state Markov modelling with a probabilistic cohort analysis to calculate the cost per quality-adjusted life year QALY gained. A one-year cycle length and a lifetime time horizon are applied. Best available evidence supplies the model with data on transition probabilities between glycaemic states, mortality risks, utility weights, and disease costs. The costs are calculated from a societal perspective. A 3% discount rate is used for costs and QALYs. Cost-effectiveness acceptability curves are presented to assist decision makers.

ResultsThe model indicates that diabetes prevention interventions have the potential to be cost-effective, but the outcome reveals a high level of uncertainty. Incremental cost-effectiveness ratios ICERs were negative for the intervention, ie, the intervention leads to a cost reduction for men and women aged 30 or 50 years at initiation of the intervention. For men and women aged 70 at initiation of the intervention, the ICER was EUR27,546-QALY gained and EUR19,433-QALY gained, respectively. In all cases, the QALYs gained were low. Cost-effectiveness acceptability curves show that the higher the willingness-to-pay threshold value, the higher the probability that the intervention is cost-effective. Nonetheless, all curves are flat. The threshold value of EUR50,000-QALY gained has a 30-55% probability that the intervention is cost-effective.

ConclusionsLifestyle interventions for primary prevention of type 2 diabetes are cost-saving for men and women aged 30 or 50 years at the start of the intervention, and cost-effective for men and women aged 70 years. However, there is a high degree of uncertainty around the ICERs. With the conservative approach adopted for this model, the long-term effectiveness of the intervention could be underestimated.

KeywordsDiabetes mellitus health care costs health care economics and organisations primary prevention life style early intervention decision making List of abbreviations usedBMIbody mass index

FINDRISKFinnish Type 2 Diabetes Risk Score

SDPPSaxon Diabetes Prevention Programme

PREDIASPrevention of Diabetes Self-Management Program

ICERincremental cost-effectiveness ratios

QALYquality-adjusted life year

NGTnormal glucose tolerance

IGTimpaired glucose tolerance

T2Dtype 2 diabetes mellitus

cNGTannual health care costs for NGT

cIGTannual health care costs for IGT

cT2Dannual health care costs for T2D

uNGThealth utility value for NGT

uIGThealth utility value for IGT

uT2Dhealth utility value for T2D

ngt2igtprobability of moving from NGT to IGT state

igt2ngtprobability of moving from IGT to NGT state

igt2igtprobability staying in IGT state

igt2t2dprobability of moving from IGT to T2D state

t2d2igtprobability of moving from T2D to IGT state

t2d2dprobability of dying from T2D state

mrageprobability of mortality in a certain age and sex group when T2D not present.

Electronic supplementary materialThe online version of this article doi:10.1186-1478-7547-9-17 contains supplementary material, which is available to authorized users.

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Autor: Anne Neumann - Peter Schwarz - Lars Lindholm


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