Chapter 27. Cost-Effectiveness of Interventions for the Prevention and Control of Diabetes

  1. William H. Herman2,
  2. Ann Louise Kinmonth3,
  3. Nicholas J. Wareham4 and
  4. Rhys Williams5
  1. Rui Li and
  2. Ping Zhang

Published Online: 12 JAN 2010

DOI: 10.1002/9780470682807.ch27

The Evidence Base for Diabetes Care, Second Edition

The Evidence Base for Diabetes Care, Second Edition

How to Cite

Li, R. and Zhang, P. (2010) Cost-Effectiveness of Interventions for the Prevention and Control of Diabetes, in The Evidence Base for Diabetes Care, Second Edition (eds W. H. Herman, A. L. Kinmonth, N. J. Wareham and R. Williams), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9780470682807.ch27

Editor Information

  1. 2

    Department of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI, USA

  2. 3

    General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

  3. 4

    MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK

  4. 5

    School of Medicine, Swansea University, Swansea, UK

Author Information

  1. Centers for Disease Control and Prevention, Atlanta, GA, USA

Publication History

  1. Published Online: 12 JAN 2010
  2. Published Print: 19 FEB 2010

ISBN Information

Print ISBN: 9780470032749

Online ISBN: 9780470682807

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Keywords:

  • diabetes mellitus;
  • prevention;
  • treatment;
  • cost;
  • benefits;
  • life-years;
  • quality-adjusted life-years;
  • cost-effectiveness analysis;
  • cost–utility analysis

Summary

This chapter describes the conceptual framework of cost-effectiveness analysis and summarizes the results of recent studies concerning the cost-effectiveness of interventions for the prevention and control of diabetes. We reviewed original research articles published in English from 1985 through 2005, converted all costs described in these articles to 2005 US dollars and reported cost-effectiveness results separately for the United States and for other developed countries (mainly countries in Europe plus Canada and Australia). Both levels of evidence and of cost-effectiveness varied by intervention. This variation also depended on region because of differences in availability of clinical trial data as well as the availability and quality of the studies. There was strong evidence to demonstrate the following interventions were either cost-saving or cost-effective. For both the United States and other regions, these interventions include (1) intensive lifestyle interventions (either individual or group-based) and generic metformin treatment for preventing type 2 diabetes among high-risk individuals and (2) angiotensin-converting enzyme (ACE) inhibitors and beta-blockers for intensive hypertension control among type 2 diabetes patients. In the United States, additional interventions included annual diabetic retinopathy screening in persons with type 1 diabetes In the other developed regions they included ACE inhibitors, losartan and irbesartan treatment for preventing nephropathy among type 2 diabetes patients, becaplermin treatment for foot ulcer for type 1 or type 2 diabetes patients, intensive glycaemic control among type 2 diabetes patients targeting at an HbA1c level of 7% or less and simvastatin treatment for secondary prevention of cardiovascular disease (CVD) among type 2 diabetes patients with dyslipidaemia. Interventions with strong evidence to demonstrate that they were not cost-effective include; universal screening for undiagnosed type 2 diabetes and intensive glycaemic control targeting at fast plasma glucose at 108°mg°dl–1 in type 2 diabetic patients aged 55 years and older in the United States. In addition, there were a large number of interventions for which evidence on cost-effectiveness was weak. There were two interventions for which evidence on cost-effectiveness was mixed because of contradictory conclusions. Interventions with strong evidence to demonstrate that they were either cost-saving or cost-effective represent good use of heath care resources and should be adopted. These with strong evidence to demonstrate they were not cost-effective represent a poor use of heath care resources and should not be adopted. More research is needed on those interventions for which evidence of cost-effectiveness was weak or mixed