Within trial cost-effectiveness of a structured lifestyle intervention in adults with overweight/obesity and type 2 diabetes: Results from the Action for Health in Diabetes (Look AHEAD) Study

OBJECTIVE To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared to standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study. RESEARCH DESIGN AND METHODS Data were from 4,827 participants during the first 9 years of the study from 2001 to 2012. Information on Health Utility Index-2 and -3, SF-6D, and Feeling Thermometer [FT]), cost of delivering the interventions, and health expenditures were collected during the study. CE was measured by incremental cost-effectiveness ratios (ICERs) in costs per quality-adjusted life year (QALY). Future costs and QALYs were discounted at 3% annually. Costs were in 2012 US dollars. RESULTS <a>Over the </a>9 years studied, the mean cumulative intervention costs and mean cumulative health care expenditures were $11,275 and $64,453 per person for ILI and $887 and $68,174 for DSE. Thus, ILI cost $6,666 more per person than DSE. Additional QALYs gained by ILI were not statistically significant measured by the HUIs and were 0.17 and 0.16, respectively, measured by SF-6D and FT. The ICERs ranged from no health benefit with a higher cost based on HUIs, to $96,458/QALY and $43,169/QALY, respectively, based on SF-6D and FT. Conclusions Whether ILI was cost-effective over the 9-year period is unclear because different health utility measures led to different conclusions.

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Cost-effectiveness of the SLIMMER diabetes prevention intervention in Dutch primary health care: economic evaluation from a randomised controlled trial

BMC Health Services Research ◽

10.1186/s12913-019-4529-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Geerke Duijzer ◽

Andrea J. Bukman ◽

Aafke Meints-Groenveld ◽

Annemien Haveman-Nies ◽

Sophia C. Jansen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Health Care ◽

Primary Health Care ◽

Cost Effectiveness ◽

Lifestyle Intervention ◽

Diabetes Prevention ◽

Cost Effective ◽

Primary Health ◽

The Cost

Abstract Background Although evidence is accumulating that lifestyle modification may be cost-effective in patients with prediabetes, information is limited on the cost-effectiveness of interventions implemented in public health and primary health care settings. Evidence from well-conducted pragmatic trials is needed to gain insight into the realistic cost-effectiveness of diabetes prevention interventions in real-world settings. The aim of this study is to assess the cost-effectiveness of the SLIMMER lifestyle intervention targeted at patients at high risk of developing type 2 diabetes compared with usual health care in a primary care setting in the Netherlands. Methods Three hundred and sixteen high-risk subjects were randomly assigned to the SLIMMER lifestyle intervention or to usual health care. Costs and outcome assessments were performed at the end of the intervention (12 months) and six months thereafter (18 months). Costs were assessed from a societal perspective. Patients completed questionnaires to assess health care utilisation, participant out-of-pocket costs, and productivity losses. Quality Adjusted Life Years (QALY) were calculated based on the SF-36 questionnaire. Cost-effectiveness planes and acceptability curves were generated using bootstrap analyses. Results The cost-effectiveness analysis showed that the incremental costs of the SLIMMER lifestyle intervention were €547 and that the incremental effect was 0.02 QALY, resulting in an incremental cost-effectiveness ratio (ICER) of €28,094/QALY. When cost-effectiveness was calculated from a health care perspective, the ICER decreased to €13,605/QALY, with a moderate probability of being cost-effective (56% at a willingness to pay, WTP, of €20,000/QALY and 81% at a WTP of €80,000/QALY). Conclusions The SLIMMER lifestyle intervention to prevent type 2 diabetes had a low to moderate probability of being cost-effective, depending on the perspective taken. Trial registration The SLIMMER study is retrospectively registered with ClinicalTrials.gov (Identifier NCT02094911) since March 19, 2014.

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Cost-effectiveness of a lifestyle intervention in preventing Type 2 diabetes

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462311000365 ◽

2011 ◽

Vol 27 (4) ◽

pp. 275-282 ◽

Cited By ~ 16

Author(s):

Lisa Irvine ◽

Garry R. Barton ◽

Amy V. Gasper ◽

Nikki Murray ◽

Allan Clark ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cost Effectiveness ◽

Incremental Cost ◽

Cost Effective ◽

Large Degree ◽

Quality Adjusted Life Year ◽

Develop Type ◽

Intervention Costs

Objectives: Previous research has suggested people with impaired fasting glucose (IFG) are less likely to develop Type 2 diabetes (T2DM) if they receive prolonged structured diet and exercise advice. This study examined the within-trial cost-effectiveness of such lifestyle interventions.Methods: Screen-detected participants with either newly diagnosed T2DM or IFG were randomized 2:1 to intervention versus control (usual care) between February and December 2009, in Norfolk (UK). The intervention consisted of group based education, physiotherapy and peer support sessions, plus telephone contacts from T2DM volunteers. We monitored healthcare resource use, intervention costs, and quality of life (EQ-5D). The incremental cost per quality-adjusted life-year (QALY) gain (incremental cost effectiveness ratio [ICER]), and cost effectiveness acceptability curves (CEAC) were estimated.Results: In total, 177 participants were recruited (118 intervention, 59 controls), with a mean follow-up of 7 months. Excluding screening and recruitment costs, the mean cost was estimated to be £551 per participant in the intervention arm, compared with £325 in the control arm. The QALY gains were –0.001 and –0.004, respectively. The intervention was estimated to have an ICER of £67,184 per QALY (16 percent probability of being cost-effective at the £20,000/QALY threshold). Cost-effectiveness estimates were more favorable for IFG participants and those with longer follow-up (≥4 months) (ICERs of £20,620 and £17,075 per QALY, respectively).Conclusions: Group sessions to prevent T2DM were not estimated to be within current limits of cost-effectiveness. However, there was a large degree of uncertainty surrounding these estimates, suggesting the need for further research.

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COST-EFFECTIVENESS OF EXERCISE PROGRAMS IN TYPE 2 DIABETES

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462312000256 ◽

2012 ◽

Vol 28 (3) ◽

pp. 228-234 ◽

Cited By ~ 10

Author(s):

Doug Coyle ◽

Kathryn Coyle ◽

Glen P. Kenny ◽

Normand G. Boulé ◽

George A. Wells ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cost Effectiveness ◽

Exercise Training ◽

Exercise Program ◽

Cost Effective ◽

Exercise Programs ◽

Combined Exercise ◽

Use Of Resources ◽

Life Years

Background: A randomized controlled trial has shown that supervised, facility-based exercise training is effective in improving glycemic control in type 2 diabetes. However, these programs are associated with additional costs. This analysis assessed the cost-effectiveness of such programs.Methods: Analysis used data from the Diabetes Aerobic and Resistance Exercise (DARE) clinical trial which compared three different exercise programs (resistance, aerobic or a combination of both) of 6 months duration with a control group (no exercise program). Clinical outcomes at 6 months were entered for individual patients into the UKPDS economic model for type 2 diabetes adapted for the Canadian context. From this, expected life-years, quality-adjusted life-years (QALYs) and costs were estimated for all patients within the trial.Results: The combined exercise program was the most expensive ($40,050) followed by the aerobic program ($39,250), the resistance program ($38,300) and no program ($31,075). QALYs were highest for combined (8.94), followed by aerobic (8.77), resistance (8.73) and no program (8.70). The incremental cost per QALY gained for the combined exercise program was $4,792 compared with aerobic alone, $8,570 compared with resistance alone, and $37,872 compared with no program. The combined exercise program remained cost-effective for all scenarios considered within sensitivity analysis.Conclusions: A program providing training in both resistance and aerobic exercise was the most cost-effective of the alternatives compared. Based on previous funding decisions, exercise training for individuals with diabetes can be considered an efficient use of resources.

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

Diabetes Care ◽

10.2337/diacare.26.9.2518 ◽

2003 ◽

Vol 26 (9) ◽

pp. 2518-2523 ◽

Cited By ~ 184

Author(s):

Keyword(s):

Type 2 Diabetes ◽

Cost Effectiveness ◽

Primary Prevention ◽

Lifestyle Intervention ◽

Trial Cost

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The cost-effectiveness of testing strategies for type 2 diabetes: a modelling study

Health Technology Assessment ◽

10.3310/hta19330 ◽

2015 ◽

Vol 19 (33) ◽

pp. 1-80 ◽

Cited By ~ 15

Author(s):

Mike Gillett ◽

Alan Brennan ◽

Penny Watson ◽

Kamlesh Khunti ◽

Melanie Davies ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cost Effectiveness ◽

High Risk ◽

Risk Score ◽

Cost Effective ◽

Data Set ◽

Uptake Rates ◽

Multiethnic Population ◽

The Cost

BackgroundAn estimated 850,000 people have diabetes without knowing it and as many as 7 million more are at high risk of developing it. Within the NHS Health Checks programme, blood glucose testing can be undertaken using a fasting plasma glucose (FPG) or a glycated haemoglobin (HbA1c) test but the relative cost-effectiveness of these is unknown.ObjectivesTo estimate and compare the cost-effectiveness of screening for type 2 diabetes using a HbA1ctest versus a FPG test. In addition, to compare the use of a random capillary glucose (RCG) test versus a non-invasive risk score to prioritise individuals who should undertake a HbA1cor FPG test.DesignCost-effectiveness analysis using the Sheffield Type 2 Diabetes Model to model lifetime incidence of complications, costs and health benefits of screening.SettingEngland; population in the 40–74-years age range eligible for a NHS health check.Data sourcesThe Leicester Ethnic Atherosclerosis and Diabetes Risk (LEADER) data set was used to analyse prevalence and screening outcomes for a multiethnic population. Alternative prevalence rates were obtained from the literature or through personal communication.Methods(1) Modelling of screening pathways to determine the cost per case detected followed by long-term modelling of glucose progression and complications associated with hyperglycaemia; and (2) calculation of the costs and health-related quality of life arising from complications and calculation of overall cost per quality-adjusted life-year (QALY), net monetary benefit and the likelihood of cost-effectiveness.ResultsBased on the LEADER data set from a multiethnic population, the results indicate that screening using a HbA1ctest is more cost-effective than using a FPG. For National Institute for Health and Care Excellence (NICE)-recommended screening strategies, HbA1cleads to a cost saving of £12 and a QALY gain of 0.0220 per person when a risk score is used as a prescreen. With no prescreen, the cost saving is £30 with a QALY gain of 0.0224. Probabilistic sensitivity analysis indicates that the likelihood of HbA1cbeing more cost-effective than FPG is 98% and 95% with and without a risk score, respectively. One-way sensitivity analyses indicate that the results based on prevalence in the LEADER data set are insensitive to a variety of alternative assumptions. However, where a region of the country has a very different joint HbA1cand FPG distribution from the LEADER data set such that a FPG test yields a much higher prevalence of high-risk cases relative to HbA1c, FPG may be more cost-effective. The degree to which the FPG-based prevalence would have to be higher depends very much on the uncertain relative uptake rates of the two tests. Using a risk score such as the Leicester Practice Database Score (LPDS) appears to be more cost-effective than using a RCG test to identify individuals with the highest risk of diabetes who should undergo blood testing.LimitationsWe did not include rescreening because there was an absence of required relevant evidence.ConclusionsBased on the multiethnic LEADER population, among individuals currently attending NHS Health Checks, it is more cost-effective to screen for diabetes using a HbA1ctest than using a FPG test. However, in some localities, the prevalence of diabetes and high risk of diabetes may be higher for FPG relative to HbA1cthan in the LEADER cohort. In such cases, whether or not it still holds that HbA1cis likely to be more cost-effective than FPG depends on the relative uptake rates for HbA1cand FPG. Use of the LPDS appears to be more cost-effective than a RCG test for prescreening.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Cost-Effectiveness of Migraine Prevention: The Case of Topiramate in the UK

Cephalalgia ◽

10.1111/j.1468-2982.2006.01240.x ◽

2006 ◽

Vol 26 (12) ◽

pp. 1473-1482 ◽

Cited By ~ 17

Author(s):

JS Brown ◽

G Papadopoulos ◽

PJ Neumann ◽

M Price ◽

M Friedman ◽

...

Keyword(s):

Cost Effectiveness ◽

Preventive Treatment ◽

Cost Effective ◽

Health Utility ◽

Quality Adjusted Life Year ◽

Migraine Prevention ◽

Migraine Frequency ◽

Cost Effective Treatment ◽

The Uk ◽

The Cost

The aim of this study was to assess the cost-effectiveness of topiramate vs. no preventive treatment in the UK. Model inputs included baseline migraine frequency, treatment discontinuation and response, preventive and acute medical cost per attack [2005 GBP (£)] and gain in health utility. Outcomes included monthly migraines averted, acute and preventive treatment costs and cost per quality-adjusted life year (QALY). Topiramate was associated with 1.8 fewer monthly migraines and a QALY gain of 0.0384. The incremental cost of topiramate vs. no preventive treatment was about £10 per migraine averted and £5700 per QALY. Results are sensitive to baseline monthly migraine frequency, triptan use rate and the gain in utility. Incorporating savings from reduced work loss (about £36 per month) suggests that topiramate would be cost saving compared with no preventive treatment. This analysis suggests that topiramate is a cost-effective treatment for migraine prevention compared with no preventive treatment.

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Patient Health Utility Equations for a Type 2 Diabetes Model

10.2337/figshare.13166159 ◽

2021 ◽

Author(s):

Simon J. Neuwahl ◽

Ping Zhang ◽

Haiying Chen ◽

Hui Shao ◽

Michael Laxy ◽

...

Keyword(s):

Type 2 Diabetes ◽

Fixed Effects ◽

Laser Photocoagulation ◽

Longitudinal Design ◽

Health Utility Index ◽

Health Utility ◽

Stroke Event ◽

Look Ahead ◽

Fixed Effects Regression

Objective: To estimate the health utility impact of diabetes-related complications in a large, longitudinal U.S. sample of people with type 2 diabetes. Research Design and Methods: We combined Health Utility Index-3 data on patients with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) and Action for Health in Diabetes (Look AHEAD) trials and their follow-on studies. Complications were classified as events if they occurred in the year preceding the utility measurement; otherwise, they were classified as a history of the complication. We estimated utility decrements associated with complications using a fixed-effects regression model. Results: Our sample included 15,252 persons with an average follow-up of 8.2 years and a total of 128,873 person-visit observations. The largest, statistically significant (p < 0.05) health utility decrements were for stroke (event: −0.109; history: −0.051), amputation (event: −0.092; history: −0.150), congestive heart failure (CHF; event: −0.051; history: −0.041), dialysis (event: −0.039), estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 (event: −0.043; history: −0.025), angina (history: −0.028), and myocardial infarction (MI) (event: −0.028). There were smaller effects for laser photocoagulation, and eGFR < 60 mL/min/1.73 m2. Decrements for dialysis history, angina event, MI history, revascularization event, revascularization history, laser photocoagulation event, and hypoglycemia were not significant (p >= 0.05) Conclusions: Using a large study sample and a longitudinal design, our estimated health utility scores are expected to be largely unbiased. Estimates can be used to describe the health utility impact of diabetes complications, improve cost-effectiveness models, and inform diabetes policies.

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Economic evaluation of population-based type 2 diabetes mellitus screening at different healthcare settings in Vietnam

PLoS ONE ◽

10.1371/journal.pone.0261231 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261231

Author(s):

Phung Lam Toi ◽

Olivia Wu ◽

Montarat Thavorncharoensap ◽

Varalak Srinonprasert ◽

Thunyarat Anothaisintawee ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cost Effectiveness ◽

Cost Effective ◽

Economic Evaluations ◽

Value For Money ◽

Healthcare Settings ◽

Annual Screening

Introduction Few economic evaluations have assessed the cost-effectiveness of screening type-2 diabetes mellitus (T2DM) in different healthcare settings. This study aims to evaluate the value for money of various T2DM screening strategies in Vietnam. Methods A decision analytical model was constructed to compare costs and quality-adjusted life years (QALYs) of T2DM screening in different health care settings, including (1) screening at commune health station (CHS) and (2) screening at district health center (DHC), with no screening as the current practice. We further explored the costs and QALYs of different initial screening ages and different screening intervals. Cost and utility data were obtained by primary data collection in Vietnam. Incremental cost-effectiveness ratios were calculated from societal and payer perspectives, while uncertainty analysis was performed to explore parameter uncertainties. Results Annual T2DM screening at either CHS or DHC was cost-effective in Vietnam, from both societal and payer perspectives. Annual screening at CHS was found as the best screening strategy in terms of value for money. From a societal perspective, annual screening at CHS from initial age of 40 years was associated with 0.40 QALYs gained while saving US$ 186.21. Meanwhile, one-off screening was not cost-effective when screening for people younger than 35 years old at both CHS and DHC. Conclusions T2DM screening should be included in the Vietnamese health benefits package, and annual screening at either CHS or DHC is recommended.

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Patient Health Utility Equations for a Type 2 Diabetes Model

10.2337/figshare.13166159.v2 ◽

2021 ◽

Author(s):

Simon J. Neuwahl ◽

Ping Zhang ◽

Haiying Chen ◽

Hui Shao ◽

Michael Laxy ◽

...

Keyword(s):

Type 2 Diabetes ◽

Fixed Effects ◽

Laser Photocoagulation ◽

Longitudinal Design ◽

Health Utility Index ◽

Health Utility ◽

Stroke Event ◽

Look Ahead ◽

Fixed Effects Regression

Objective: To estimate the health utility impact of diabetes-related complications in a large, longitudinal U.S. sample of people with type 2 diabetes. Research Design and Methods: We combined Health Utility Index-3 data on patients with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) and Action for Health in Diabetes (Look AHEAD) trials and their follow-on studies. Complications were classified as events if they occurred in the year preceding the utility measurement; otherwise, they were classified as a history of the complication. We estimated utility decrements associated with complications using a fixed-effects regression model. Results: Our sample included 15,252 persons with an average follow-up of 8.2 years and a total of 128,873 person-visit observations. The largest, statistically significant (p < 0.05) health utility decrements were for stroke (event: −0.109; history: −0.051), amputation (event: −0.092; history: −0.150), congestive heart failure (CHF; event: −0.051; history: −0.041), dialysis (event: −0.039), estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 (event: −0.043; history: −0.025), angina (history: −0.028), and myocardial infarction (MI) (event: −0.028). There were smaller effects for laser photocoagulation, and eGFR < 60 mL/min/1.73 m2. Decrements for dialysis history, angina event, MI history, revascularization event, revascularization history, laser photocoagulation event, and hypoglycemia were not significant (p >= 0.05) Conclusions: Using a large study sample and a longitudinal design, our estimated health utility scores are expected to be largely unbiased. Estimates can be used to describe the health utility impact of diabetes complications, improve cost-effectiveness models, and inform diabetes policies.

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