Lifestyle Interventions Are Cost-Effective in People With Different Levels of Diabetes Risk

Abstract

OBJECTIVE -In the current study we explore the long-term health benefits and costeffectiveness of both a community-based lifestyle program for the general population (community intervention) and an intensive lifestyle intervention for obese adults, implemented in a health care setting (health care intervention).RESEARCH DESIGN AND METHODS -Short-term intervention effects on BMI and physical activity were estimated from the international literature. The National Institute for Public Health and the Environment Chronic Diseases Model was used to project lifetime health effects and effects on health care costs for minimum and maximum estimates of short-term intervention effects. Cost-effectiveness was evaluated from a health care perspective and included intervention costs and related and unrelated medical costs. Effects and costs were discounted at 1.5 and 4.0% annually.RESULTS -One new case of diabetes per 20 years was prevented for every 7-30 participants in the health care intervention and for every 300 -1,500 adults in the community intervention. Intervention costs needed to prevent one new case of diabetes (per 20 years) were lower for the community intervention (€2,000 -9,000) than for the health care intervention (€5,000 -21,000). The cost-effectiveness ratios were €3,100 -3,900 per quality-adjusted life-year (QALY) for the community intervention and €3,900 -5,500 per QALY for the health care intervention.CONCLUSIONS -Health care interventions for high-risk groups and community-based lifestyle interventions targeted to the general population (low risk) are both cost-effective ways of curbing the growing burden of diabetes. Diabetes Care 30:128 -134, 2007R isk factors for developing type 2 diabetes include a high body weight, physical inactivity, and smoking, whereas moderate consumption of alcohol or coffee appears to be protective (1-9). The most serious of these factors is overweight. With every 1 unit increase in BMI, the risk of developing type 2 diabetes increases by ϳ10 -30% (10). There is substantial evidence that lifestyle interventions focused on diet and physical exercise can reduce diabetes incidence in individuals at high risk of developing diabetes (11)(12)(13)(14). Although the direct effect of lifestyle interventions on diabetes incidence in other target populations is relatively unknown, it is suggested that a relatively small shift of the entire general population toward more healthy behavior could lead to a reduction in the incidence of diabetes (15).Modeling can be used to assess the potential long-term impact of lifestyle programs on future health and health care costs. Such information is interesting to policy makers who have to decide on optimal allocation of limited budgets. Models have been used to demonstrate that intensive lifestyle modification programs are cost-effective for individuals at high risk of developing diabetes (16,17). However, the cost-effectiveness of such interventions for individuals at lower risk of developing diabetes is relatively unknown (15,16,18 -20). The inc...

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