The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance
The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance
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DOI：
10.7326/0003-4819-142-5-200503010-00007
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发表时间：
2005-03-01
影响因子：
39.2
通讯作者：
Ratner, RE
中科院分区：
文献类型：
--
作者：
Herman, WH;Hoerger, TJ;Ratner, RE
背景：糖尿病预防计划(DPP)证明干预措施可以延缓或预防2型糖尿病的发展。目的：评估DPP干预措施的终生成本效用。设计：马尔可夫模拟模型以估计疾病的进展、成本和生活质量。数据来源：DPP和已发表的报告。目标人群：DPP队列中25岁或以上的糖耐量受损成员。时间范围：终生。视角：卫生系统和社会。干预措施：密集的生活方式、二甲双胍和安慰剂干预。结果衡量：糖尿病、微血管和神经并发症、心血管并发症、生存率、安慰剂干预的累积发生率基础病例分析结果：与安慰剂干预相比，生活方式和二甲双胍干预分别使2型糖尿病的发展延迟了11年和3年，糖尿病的绝对发病率分别降低了20%和8%。微血管、神经病变和心血管并发症的累积发生率降低，生存时间分别提高了0.5年和0.2年。与安慰剂干预相比，生活方式干预的每QALY成本约为1,100美元，二甲双胍干预的每QALY成本约为31300美元。从社会角度来看，每QALY的干预成本分别约为8800美元和29900美元。从这两个角度来看，生活方式干预在二甲双胍干预中占主导地位。敏感度分析结果：当干预措施实施时，成本-效果得到了改善，就像在常规临床实践中一样。生活方式干预在所有年龄段都是具有成本效益的。二甲双胍干预并不代表65岁以上人群对资源的良好利用。限制：模拟结果取决于基本假设的准确性，包括参与者的依从性。结论：卫生政策应促进高危人群预防糖尿病。
Background: The Diabetes Prevention Program (DPP) demonstrated that interventions can delay or prevent the development of type 2 diabetes.Objective: To estimate the lifetime cost-utility of the DPP interventions.Design: Markov simulation model to estimate progression of disease, costs, and quality of life.Data Sources: The DPP and published reports.Target Population: Members of the DPP cohort 25 years of age or older with impaired glucose tolerance.Time Horizon: Lifetime.Perspectives: Health system and societal.Interventions: intensive lifestyle, metformin, and placebo interventions as implemented in the DPP.Outcome Measures: Cumulative incidence of diabetes, microvascular and neuropathic complications, cardiovascular complications, survival, direct medical and direct nonmedical costs, quality-adjusted life-years (QALYs), and cost per QALY.Results of Base-Case Analysis: Compared with the placebo intervention, the lifestyle and metformin interventions were estimated to delay the development of type 2 diabetes by 11 and 3 years, respectively, and to reduce the absolute incidence of diabetes by 20% and 8%, respectively. The cumulative incidence of microvascular, neuropathic, and cardiovascular complications were reduced and survival was improved by 0.5 and 0.2 years. Compared with the placebo intervention, the cost per QALY was approximately $1100 for the lifestyle intervention and $31300 for the metformin intervention. From a societal perspective, the interventions cost approximately $8800 and $29 900 per QALY, respectively. From both perspectives, the lifestyle intervention dominated the metformin intervention.Results of Sensitivity Analysis: Cost-effectiveness improved when the interventions were implemented as they might be in routine clinical practice. The lifestyle intervention was cost-effective in all age groups. The metformin intervention did not represent good use of resources for persons older than 65 years of age.Limitations: Simulation results depend on the accuracy of the underlying assumptions, including participant adherence.Conclusions: Health policy should promote diabetes prevention in high-risk individuals.