Study presented at the American Diabetes Association's 71st Scientific Sessions, held from June 24 to 28 in San Diego
Tuesday, June 28,
Abstract No: 0136-LBOR
Abstract Type: Late Breaking Oral
Author(s): WILLIAM H. HERMAN, SHARON L. EDELSTEIN, ROBERT E. RATNER, MARIA G. MONTEZ, RONALD T. ACKERMANN, TREVOR J. ORCHARD, MARY A. FOULKES, PING ZHANG, CHRISTOPHER D. SAUDEK, MORTON B. BROWN, THE DIABETES PREVENTION PROGRAM RESEARCH GROUP
Rockville, MD, Washington, DC, San Antonio, TX, Indianapolis, IN, Pittsburgh, PA, Atlanta, GA, Baltimore, MD, Ann Arbor, MI
The Diabetes Prevention Program (DPP) randomized overweight adults with impaired glucose tolerance (IGT) and an elevated fasting glucose to intensive lifestyle (ILS), metformin (MET), or placebo (PBO) for an average of 3 years. The DPP Outcomes Study (DPPOS) followed participants for an additional 7 years during which time ILS and MET participants were encouraged to continue those interventions and all participants were offered a modified lifestyle intervention. A recent analysis demonstrated that the beneficial effects of ILS and MET on the incidence of type 2 diabetes persisted for at least 10 years after randomization. During both DPP and DPPOS, data on resource utilization, cost, and quality-of-life were collected prospectively. Economic analyses were performed from a health system perspective that considered direct medical costs. During DPPOS, the direct medical costs of ILS and MET were substantially lower than during DPP, and the costs of PBO were higher than during DPP. Over 10 years, the cumulative, undiscounted, per capita direct medical costs of the interventions were greater for ILS and MET than for PBO ($4,826 ILS vs. $2,489 MET vs. $953 PBO). The direct medical costs of care outside the DPP/DPPOS increased over time for all groups, but were highest for PBO. The cumulative undiscounted, per capita, direct medical costs of non-intervention-related medical care were greater for PBO ($31,299) than MET ($26,351) or ILS ($24,759). Over 10 years, the undiscounted per capita total direct medical costs were lower for both ILS ($29,585) and MET ($27,840) compared to PBO ($32,252). Quality-of-life was better for ILS compared to MET or PBO and the undiscounted quality-adjusted life-years accrued over 10 years were greater for ILS (6.81) than MET (6.69) or PBO (6.67 QALYs). Over 10 years, from a payer perspective, ILS and MET were less expensive and more effective than PBO. Both health policy and social policy should support the funding of intensive lifestyle and metformin for diabetes prevention in high-risk adults.