Rui Li, PhD; Shuli Qu, MPH; Ping Zhang, PhD; Sajal Chattopadhyay, PhD; Edward W. Gregg, PhD; Ann Albright, PhD; David Hopkins, MD; Nicolaas P. Pronk, PhD
Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Acknowledgment: The authors thank William Thomas, MLIS, from the Library Science Branch at the Centers for Disease Control and Prevention for doing the literature search; Verughese Jacob, PhD, from the Community Guide Branch at the Centers for Disease Control and Prevention for his assistance in the study design, data abstraction, and graphical support; and Kate W. Harris, BA, for her help in editing the manuscript. They also thank Elizabeth Luman, PhD, from the Division of Diabetes Translation; Lawrence E. Barker, PhD, from the Division of Community Health; and the other internal reviewers from the Center for Surveillance, Epidemiology and Laboratory Services for their insightful comments on revising the manuscripts, as well as Tao Ran, PhD, from the Community Guide Branch for graphical support. In addition, the authors thank the Community Preventive Services Task Force for its contributions to this evidence review.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0469.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol, statistical code, and data set: Available from Dr. Li (e-mail, email@example.com).
Requests for Single Reprints: Rui Li, PhD, Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Highway Northeast, MS F-75, Atlanta, GA 30341; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Li, Zhang, Gregg, and Albright: Centers for Disease Control and Prevention, 4770 Buford Highway Northeast, MS F-75, Atlanta, GA 30341.
Ms. Qu and Drs. Chattopadhyay and Hopkins: Centers for Disease Control and Prevention, 4770 Buford Highway Northeast, MS E-69, Atlanta, GA 30341.
Dr. Pronk: HealthPartners Research Foundation, 70 33rd Avenue South, Mailstop HBG/21111H, Minneapolis, MN 55425.
Author Contributions: Conception and design: R. Li, S. Qu, P. Zhang, S. Chattopadhyay, D. Hopkins, N.P. Pronk.
Analysis and interpretation of the data: R. Li, S. Qu, P. Zhang, S. Chattopadhyay, A. Albright, D. Hopkins, N.P. Pronk.
Drafting of the article: R. Li, S. Qu, S. Chattopadhyay, A. Albright.
Critical revision of the article for important intellectual content: R. Li, S. Qu, P. Zhang, S. Chattopadhyay, E.W. Gregg, A. Albright, D. Hopkins, N.P. Pronk.
Final approval of the article: R. Li, S. Qu, P. Zhang, S. Chattopadhyay, E.W. Gregg, A. Albright, D. Hopkins, N.P. Pronk.
Provision of study materials or patients: R. Li.
Statistical expertise: R. Li, S. Qu, S. Chattopadhyay.
Administrative, technical, or logistic support: R. Li, S. Qu, S. Chattopadhyay, E.W. Gregg, D. Hopkins.
Collection and assembly of data: R. Li.
Li R, Qu S, Zhang P, Chattopadhyay S, Gregg EW, Albright A, et al. Economic Evaluation of Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force. Ann Intern Med. 2015;163:452-460. doi: 10.7326/M15-0469
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Published: Ann Intern Med. 2015;163(6):452-460.
Diabetes is a highly prevalent and costly disease. Studies indicate that combined diet and physical activity promotion programs can prevent type 2 diabetes among persons at increased risk.
To systematically evaluate the evidence on cost, cost-effectiveness, and cost–benefit estimates of diet and physical activity promotion programs.
Cochrane Library, EMBASE, MEDLINE, PsycINFO, Sociological Abstracts, Web of Science, EconLit, and CINAHL through 7 April 2015.
English-language studies from high-income countries that provided data on cost, cost-effectiveness, or cost–benefit ratios of diet and physical activity promotion programs with at least 2 sessions over at least 3 months delivered to persons at increased risk for type 2 diabetes.
Dual abstraction and assessment of relevant study details.
Twenty-eight studies were included. Costs were expressed in 2013 U.S. dollars. The median program cost per participant was $653. Costs were lower for group-based programs (median, $417) and programs implemented in community or primary care settings (median, $424) than for the U.S. DPP (Diabetes Prevention Program) trial and the DPP Outcomes Study ($5881). Twenty-two studies assessed the incremental cost-effectiveness ratios (ICERs) of the programs. From a health system perspective, 16 studies reported a median ICER of $13 761 per quality-adjusted life-year (QALY) saved. Group-based programs were more cost-effective (median, $1819 per QALY) than those that used individual sessions (median, $15 846 per QALY). No cost–benefit studies were identified.
Information on recruitment costs and cost-effectiveness of translational programs implemented in community and primary care settings was limited.
Diet and physical activity promotion programs to prevent type 2 diabetes are cost-effective among persons at increased risk. Costs are lower when programs are delivered to groups in community or primary care settings.
Appendix Table 1. Search Strategy: Combined Diet and Physical Activity Promotion Programs Among Persons at Increased Risk—Economic Review*
Summary of evidence search and selection.
* Studies had abstracts only, were irrelevant, or did not meet inclusion criteria.
† Did not meet inclusion criteria (for example, included persons with diabetes or had physical activity or diet component but not both). Two studies were conducted in low- or middle-income countries, and 1 did not follow a rigorous cost–benefit analysis.
Appendix Table 2. Summary Evidence Table of Included Studies Providing Cost of Combined Diet and Physical Activity Promotion Programs to Reduce Type 2 Diabetes Among Persons at Increased Risk
Table 1. Comparison of Program Costs, by Program Delivery Setting, Method, and Personnel
Appendix Table 3. Summary Evidence Table of Included Studies Providing Cost-Effectiveness of Combined Diet and Physical Activity Promotion Programs to Reduce Type 2 Diabetes Among Persons at Increased Risk
Scatterplot of ICERs from 16 cost-effectiveness or cost–utility analyses that reported cost per QALY saved from the health system perspective.
DPP = Diabetes Prevention Program; ICER = incremental cost-effectiveness ratio; IQI = interquartile interval; QALY = quality-adjusted life-year.
* $13 761 per QALY saved (IQI, $3067 to $21 899).
Table 2. Comparison of Costs per QALY Saved, by Dimension
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