The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS.
The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS.
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DOI：
10.2337/dc11-1468
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发表时间：
2012-04
期刊：
影响因子：
16.2
通讯作者：
Diabetes Prevention Program Research Group
中科院分区：
文献类型：
--
作者：
Diabetes Prevention Program Research Group
糖尿病预防计划（DPP）及其结局研究（DPPOS）表明，无论是强化生活方式干预还是二甲双胍，都可以在随机分组后至少10年内预防高危成人的2型糖尿病。我们报告了干预措施的10年试验内成本效益。前瞻性地收集资源利用、成本和生活质量的数据。从卫生系统和社会的角度进行了经济分析。10年来，在DPP期间实施的干预措施的累积未贴现人均直接医疗费用（4，601美元）高于二甲双胍（2，300美元）或安慰剂（769美元）。DPP/DPPOS以外的累计直接医疗费用在生活方式方面最低（生活方式24，563美元，二甲双胍25，616美元，安慰剂27，468美元）。累积的总直接医疗费用最高的是生活方式，最低的是二甲双胍（29，164美元的生活方式vs 27，915美元的二甲双胍vs 28，236美元的安慰剂）。生活方式组（6.81）的10年累积质量调整生命年（Qs）大于二甲双胍组（6.69）或安慰剂组（6.67）。当成本和结果以3%折现时，生活方式成本为10，037美元/QALY，二甲双胍的成本略低，QALY与安慰剂几乎相同。10年来，从支付者的角度来看，生活方式具有成本效益，与安慰剂相比，二甲双胍略微节省成本。投资于生活方式和二甲双胍干预以预防高危成人糖尿病，可提供良好的物有所值。
The Diabetes Prevention Program (DPP) and its Outcomes Study (DPPOS) demonstrated that either intensive lifestyle intervention or metformin could prevent type 2 diabetes in high-risk adults for at least 10 years after randomization. We report the 10-year within-trial cost-effectiveness of the interventions. Data on resource utilization, cost, and quality of life were collected prospectively. Economic analyses were performed from health system and societal perspectives. Over 10 years, the cumulative, undiscounted per capita direct medical costs of the interventions, as implemented during the DPP, were greater for lifestyle ($4,601) than metformin ($2,300) or placebo ($769). The cumulative direct medical costs of care outside the DPP/DPPOS were least for lifestyle ($24,563 lifestyle vs. $25,616 metformin vs. $27,468 placebo). The cumulative, combined total direct medical costs were greatest for lifestyle and least for metformin ($29,164 lifestyle vs. $27,915 metformin vs. $28,236 placebo). The cumulative quality-adjusted life-years (QALYs) accrued over 10 years were greater for lifestyle (6.81) than metformin (6.69) or placebo (6.67). When costs and outcomes were discounted at 3%, lifestyle cost $10,037 per QALY, and metformin had slightly lower costs and nearly the same QALYs as placebo. Over 10 years, from a payer perspective, lifestyle was cost-effective and metformin was marginally cost-saving compared with placebo. Investment in lifestyle and metformin interventions for diabetes prevention in high-risk adults provides good value for the money spent.
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影响因子：
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