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

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 costwas estimated to be 551 pound per participant in the intervention arm, compared with 325 pound 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 pound per QALY (16 percent probability of being cost-effective at the 20,000 pound/QALY threshold). Cost-effectiveness estimates were more favorable for IFG participants and those with longer follow-up (>= 4 months) (ICERs of 20,620 pound and 17,075 pound 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.