Clinical trials in Sweden, China, Finland, Canada, and the United States have shown that interventions involving diet, physical activity, or certain pharmacotherapies (metformin or acarbose) can reduce the risk for type 2 diabetes by 25% to 58% (10 - 13). In the Diabetes Prevention Program, a 3-year clinical trial, lifestyle intervention and metformin therapy annually cost approximately $1000 more per participant than did the placebo or standard lifestyle intervention (14). Lifestyle intervention and metformin therapy cost $17 200 and $34 500, respectively, per case of diabetes prevented or delayed, or $34 600 and $109 600 per QALY gained. If the individual intervention used in this study could have been delivered in a group setting at similar levels of effectiveness (17), costs per QALY gained would be $5200. Similarly, if a generic version of metformin rather than the brand-name drug (Glucophage, Bristol-Myers Squibb Co., Princeton, New Jersey) had been used, the cost per QALY gained would decrease to $43 800.