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Diabetes Prevention Efforts Worth Every Penny
Diabetes Prevention Efforts Worth Every Penny -- Posted by Gumbo on 03-06-05 06:56
Diabetes Prevention Efforts Worth Every Penny
Source: University of Michigan Health System
NEWSWISE Medical News, 28-Feb-2005 --
More than 40 million Americans face a high risk of developing Type 2
diabetes, and it would cost a lot to give all of them intensive help with
diet and exercise, or medication, to keep them from developing diabetes.
But not helping them would cost a lot, too - and would do nothing to stem
the nation´s diabetes epidemic and its vastly expensive medical
consequences, according to a new study in the March issue of the Annals of
Internal Medicine.
The study is the first to show that it would be cost-effective for society
to try to prevent diabetes in people with a condition known as
"pre-diabetes," or impaired glucose tolerance. An estimated 41 million
Americans have the condition, in which blood sugar levels are higher than
normal. Pre-diabetes is closely linked to obesity.
The new research shows that the costs of diabetes prevention are well within
the range that American society has previously accepted for other preventive
and curative health efforts.
The authors, led by a diabetes researcher from the University of Michigan
Health System, conclude that American health policy should immediately begin
promoting diabetes prevention in high-risk people. An accompanying
editorial, by the leader of a large Finnish diabetes study, concurs.
The findings are based on sophisticated computer modeling of data from a
large national clinical trial completed in 2001. It showed that in just
three years, a one-on-one weight loss and exercise program substantially
reduced the chance that a person with pre-diabetes would develop diabetes.
It also showed that a diabetes drug called metformin can have a smaller, but
still significant, preventive effect.
That study of 3,234 Americans, called the Diabetes Prevention Project, was
funded by the National Institutes of Health, the Centers for Disease Control
and Prevention, the American Diabetes Association and two pharmaceutical
companies.
"By projecting the DPP´s findings into the future, and factoring in all
costs including the future cost of diabetes complications, we were able to
show cost-effectiveness on a societal basis, and in some age groups, cost
savings compared with no action," says lead author William Herman, M.D.,
MPH, director of the Michigan Diabetes Research and TrainiMHS.
Three years after DPP´s results were published, he says, it hasn´t had the
major impact on clinical practice that the researchers would have hoped for,
because of cost concerns. He hopes the new paper will change that.
"The bottom line is, we shouldn´t be asking if we can afford to reach out to
every at-risk person and help them reduce their risk," says Herman. "The
real question is, in the face of today´s epidemic of obesity, can we afford
not to?"
About half of the DPP participants were African American, American Indian,
Asian American, Pacific Islander, or Hispanic American/Latino, because of
the high risk of Type 2 diabetes in those groups. The DPP lifestyle
intervention included brisk walking for 30 minutes five days a week, lowered
fat and calorie intake, and a weight-reduction goal of 7 percent of body
weight. Those who took metformin, and those in the placebo group, received
information on exercise and diet.
In just three years, the risk of developing Type 2 diabetes was reduced by
58 percent among those in the lifestyle change group, and 31 percent in the
metformin group.
The new study´s computer model shows that a lifestyle-change program could
delay the onset of diabetes by an average of 11 years and reduce the risk of
developing diabetes by 20 percent, when compared with no intervention.
Twice-daily doses of 850 milligrams of metformin would delay the onset by 3
years, on average, and lead to an 8 percent reduction in the overall risk of
diabetes.
Neither intervention would prevent every case of diabetes. But both
approaches would spare many individuals, and society, the costs of long-term
blood-sugar monitoring and medications, and the cost of treating the
expensive complications of diabetes that may occur later in life, including
blindness, kidney failure, disabling nerve damage and heart disease.
The result would be a better quality of life, and longer life, than many
would have otherwise had. The researchers used a measure called sted life
year" or QALY to calculate how diabetes and its complications, or delaying
the onset of diabetes, would affect the length and quality of a person´s
life.
"The QALY measure is often used to evaluate whether spending money on a
treatment is worthwhile for society," explains Herman, a professor of
internal medicine at the U-M Medical School and of epidemiology at the U-M
School of Public Health. "Preventive steps that cost less than $20,000 per
QALY are generally considered affordable. There´s debate over the value of
treatments that cost more than that. Those over $100,000 are often
considered to be too expensive."
The new analysis showed that, over a lifetime, intensive lifestyle
interventions for people with pre-diabetes would cost society $8,800 for
every QALY saved, making it highly cost-effective.
This number includes costs of both the intervention and of an individual´s
medical care for all conditions, related to diabetes or not. If the
lifestyle efforts were done in small groups rather than one-on-one, the cost
would be less. And even if the diabetes-delaying effects of the lifestyle
intervention were half of what was observed in the DPP, the effort would
still be cost-effective.
On the other hand, giving people with pre-diabetes doses of metformin to
reduce their blood sugar would cost society $29,000 per QALY saved, if the
brand-name drug Glucophage was used, the researchers found. If a generic
equivalent drug was used, the cost would be less. Metformin was still within
the cost-effective range for most people, except those over age 65.
The researchers also calculated the direct medical costs (or savings) of the
intervention (lifestyle change, medication or placebo) and the direct cost
of diabetes care and treatment of complications.
In this analysis, the lifestyle-modification option would actually cost less
than placebo for people between the ages of 25 and 44; for people who took
part in group sessions rather than individual sessions; and each got half as
much benefit from the program as DPP participants.
In addition to Herman, the study´s authors are Thomas Hoerger, Ph.D.,
Michael Brandle, M.D., M.S., Katherine Hicks, M.S., Stephen Sorenson, Ph.D.,
Ping Zhang, Ph.D., Richard Hamman, M.D., Dr.PH., Ronald Ackerman, M.D., MPH,
Michael Englegau, M.D., M.S. and Robert Ratner, M.D., for the DPP Research
Group. The editorial accompanying the paper is by Jaakko Tuomilehto, M.D.,
Ph.D., MPolSc, of the University of Helsinki, Finland.
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