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The Cost-Effectiveness of Lifestyle Modification or Metformin in Preventing Type 2 Diabetes in Adults with Impaired Glucose Tolerance

William H. Herman, MD, MPH; Thomas J. Hoerger, PhD; Michael Brandle, MD, MS; Katherine Hicks, MS; Stephen Sorensen, PhD; Ping Zhang, PhD; Richard F. Hamman, MD, DrPH; Ronald T. Ackermann, MD, MPH; Michael M. Engelgau, MD, MS; Robert E. Ratner, MD, Diabetes Prevention Program Research Group*
[+] Article and Author Information

From University of Michigan Health System, Ann Arbor, Michigan; RTI International, Research Triangle Park, North Carolina; Centers for Disease Control and Prevention, Atlanta, Georgia; University of Colorado Health Sciences Center, Denver, Colorado; Indiana University School of Medicine, Indianapolis, Indiana; and Medstar Research Institute, Hyattsville, Maryland.


Grant Support: By the Diabetes Prevention Program, National Institutes of Health through the National Institute of Diabetes and Digestive and Kidney Diseases, Office of Research on Minority Health, National Institute of Child Health and Human Development, and National Institute on Aging; Centers for Disease Control and Prevention; Indian Health Service; General Clinical Research Program; National Center for Research Resources; American Diabetes Association; Bristol-Myers Squibb; and Parke-Davis.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: The Diabetes Prevention Program Coordinating Center, George Washington University Biostatistics Center, 6100 Executive Boulevard, Suite 750, Rockville, MD 20852; e-mail, dppmail@biostat.bsc.gwu.edu.

Current Author Addresses: Dr. Herman: University of Michigan Health System, 1500 East Medical Center Drive, 3920 Taubman Center, Box 0354, Ann Arbor, MI 48109-0354.

Dr. Hoerger and Ms. Hicks: RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27599-2194.

Dr. Brandle: Division of Endocrinology and Diabetes, Department of Internal Medicine, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.

Dr. Sorensen: Division of Diabetes Translation, MS K-10, 4770 Buford Highway NE, Atlanta, GA 30341-3724.

Drs. Zhang and Engelgau: Division of Diabetes Translation, MS K-10, 2858 Woodcock Boulevard, Atlanta, GA 30341.

Dr. Hamman: Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Box B119, Denver, CO 80262.

Dr. Ackermann: Indiana University School of Medicine, 250 University Boulevard, Suite 122, Indianapolis, IN 46202.

Dr. Ratner: Medstar Research Institute, 6495 New Hampshire Avenue, Suite 201, Hyattsville, MD 20783.

Author Contributions: Conception and design: W.H. Herman, T.J. Hoerger, K. Hicks, S. Sorensen, P. Zhang, R.F. Hamman, R.T. Ackermann, M.M. Engelgau, R.E. Ratner.

Analysis and interpretation of the data: W.H. Herman, T.J. Hoerger, M. Brandle, K. Hicks, S. Sorensen, P. Zhang, R.F. Hamman, R.T. Ackermann, M.M. Engelgau, R.E. Ratner.

Drafting of the article: W.H. Herman, T.J. Hoerger, M. Brandle, K. Hicks, S. Sorensen, P. Zhang, R.F. Hamman, R.T. Ackermann, M.M. Engelgau.

Critical revision of the article for important intellectual content: W.H. Herman, T.J. Hoerger, M. Brandle, K. Hicks, S. Sorensen, P. Zhang, R.F. Hamman, R.T. Ackermann, M.M. Engelgau, R.E. Ratner.

Final approval of the article: W.H. Herman, T.J. Hoerger, K. Hicks, S. Sorensen, P. Zhang, R.T. Ackermann, M.M. Engelgau, R.E. Ratner.

Provision of study materials or patients: P. Zhang.

Statistical expertise: W.H. Herman, T.J. Hoerger, K. Hicks, S. Sorensen, P. Zhang.

Obtaining of funding: W.H. Herman, T.J. Hoerger, K. Hicks, M.M. Engelgau. Administrative, technical, or logistic support: W.H. Herman, S. Sorensen, R.F. Hamman, M.M. Engelgau.

Collection and assembly of data: W.H. Herman, P. Zhang.


Ann Intern Med. 2005;142(5):323-332. doi:10.7326/0003-4819-142-5-200503010-00007
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We previously demonstrated that the DPP lifestyle and metformin interventions were more expensive than placebo intervention (7). Yet, delaying or preventing type 2 diabetes delays or prevents the direct medical costs of diabetes, including the costs of diabetes education and nutritional counseling, glucose monitoring, treatment, surveillance for complications, and treatment of complications. It also improves quality of life and length of life. We recently demonstrated that from the perspective of a health system over 3 years and relative to the placebo intervention, the lifestyle and metformin interventions cost $16 000 and $31 000 per case of diabetes prevented and $32 000 and $100 000 per QALY, respectively (8). Adopting a 3-year time horizon overestimates treatment costs and underestimates the benefits of the lifestyle and metformin interventions (8). In this paper, we aimed to extend the results of our previous analyses and project the costs, health outcomes, and cost-effectiveness of the lifestyle and metformin interventions relative to the placebo intervention over a lifetime.

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Figure.
Simulated cumulative incidence of diabetes among adults with impaired glucose tolerance by the Diabetes Prevention Program treatment group.
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Summary for Patients

The Cost-Effectiveness of Strategies To Prevent Type 2 Diabetes

The summary below is from the full report titled “The Cost-Effectiveness of Lifestyle Modification or Metformin in Preventing Type 2 Diabetes in Adults with Impaired Glucose Tolerance.” It is in the 1 March 2005 issue of Annals of Internal Medicine (volume 142, pages 323-332). The authors are W.H. Herman, T.J. Hoerger, M. Brandle, K. Hicks, S. Sorensen, P. Zhang, R.F. Hamman, R.T. Ackermann, M.M. Engelgau, and R.E. Ratner, for the Diabetes Prevention Program Research Group.

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