No abstract

Objective The Da Qing Diabetes Prevention program (DQDP) was a randomized lifestyle modification intervention conducted in 1986 for the prevention and control of type 2 diabetes in individuals with impaired glucose tolerance. The current study estimated long-term cost-effectiveness of the program based on the health utilities from the Chinese population. Methods A Markov Monte Carlo model was developed to estimate the impact of the intervention from the healthcare system perspective. The analysis was run over 30-year and lifetime periods and costs were estimated respectively as health management service costs. Baseline characteristics and intervention effects were assessed from the DQDP. Utilities and costs were generated from relevant literature. The outcome measures were program cost per quality-adjusted life-years (QALYs) gained and incremental cost-effectiveness ratio (ICER) of the intervention. Sensitivity analyses and threshold analyses were performed. Results Using a 30-year horizon, the intervention strategy was cost-saving and was associated with better health outcomes (increase of 0.74 QALYs per intervention participant). Using a lifetime horizon, the intervention strategy was cost-saving and was associated with additional 1.44 QALYs. Sensitivity analyses showed that the overall ICER was most strongly influenced by the hazard ratio of cardiovascular disease event. Conclusions The Da Qing lifestyle intervention in a Chinese population with impaired glucose tolerance is likely to translate into substantial economic value. It is cost-saving over a 30-year time and lifetime frame.

It is known that health risk behaviors (HRBs) can lead to a variety of physical and mental health problems among adolescents, but few studies have paid attention to the relationship between latent classes of HRBs and adolescent diseases. The purpose of this study was to use latent class analysis (LCA) to clarify the potential subgroups of HRBs (smoking, drinking, screen time, non-suicidal self-injuries, suicidal behaviors, and unintentional injuries) and examine the association between the subgroups of HRBs and physical disorders (diarrhea, fever, cough, and vomiting) with multiple logistic regression analysis, in Chinese adolescents. Self-reported HRBs and physical disorders were used to evaluate 22,628 middle school students in six cities of China, from November 2015 to January 2016, based on a multistage stratified cluster sampling approach. The prevalence of diarrhea, fever, cough, and vomiting was 23.5%, 15.9%, 50.6%, and 10.7%, respectively. We identified four latent classes of HRBs by LCA, including low-risk class, moderate-risk class 1 (smoking, drinking, and screen time), moderate-risk class 2 (non-suicidal self-injuries and suicidal behaviors, unintentional injuries), and high-risk class (smoking, drinking, screen time, non-suicidal self-injuries, suicidal behaviors, and unintentional injuries), which were 64.0%, 4.5%, 28.8% and 2.7% of participants, respectively. Compared to the low-risk class, all other classes showed higher risk for these physical disorders (P < 0.01 for each). In particular, the high-risk class had the highest risk (diarrhea (odds ratio (OR) = 2.628, 95% confidence interval (CI) 2.219 to 3.113), fever (OR = 3.103, 95% CI 2.591 to 3.717), cough (OR = 2.142, 95% CI 1.805 to 2.541), and vomiting (OR = 3.738, 95% CI 3.081 to 4.536). In conclusion, these results indicated that heterogeneity exists in HRBs, and subgroups of HRBs were correlated to the occurrence of common physical disorders in Chinese adolescents. Therefore, multiple HRBs rather than single factors should be considered for the prevention of common physical disorders in schools.