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2017 ; 7
(11
): e017184
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English Wikipedia
Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of
lifestyle programmes and metformin, with and without screening, for pre-diabetes
#MMPMID29146638
Roberts S
; Barry E
; Craig D
; Airoldi M
; Bevan G
; Greenhalgh T
BMJ Open
2017[Nov]; 7
(11
): e017184
PMID29146638
show ga
OBJECTIVE: Explore the cost-effectiveness of lifestyle interventions and
metformin in reducing subsequent incidence of type 2 diabetes, both alone and in
combination with a screening programme to identify high-risk individuals. DESIGN:
Systematic review of economic evaluations. DATA SOURCES AND ELIGIBILITY CRITERIA:
Database searches (Embase, Medline, PreMedline, NHS EED) and citation tracking
identified economic evaluations of lifestyle interventions or metformin alone or
in combination with screening programmes in people at high risk of developing
diabetes. The International Society for Pharmaco-economics and Outcomes
Research's Questionnaire to Assess Relevance and Credibility of Modelling Studies
for Informing Healthcare Decision Making was used to assess study quality.
RESULTS: 27 studies were included; all had evaluated lifestyle interventions and
12 also evaluated metformin. Primary studies exhibited considerable heterogeneity
in definitions of pre-diabetes and intensity and duration of lifestyle
programmes. Lifestyle programmes and metformin appeared to be cost effective in
preventing diabetes in high-risk individuals (median incremental
cost-effectiveness ratios of £7490/quality-adjusted life-year (QALY) and
£8428/QALY, respectively) but economic estimates varied widely between studies.
Intervention-only programmes were in general more cost effective than programmes
that also included a screening component. The longer the period evaluated, the
more cost-effective interventions appeared. In the few studies that evaluated
other economic considerations, budget impact of prevention programmes was
moderate (0.13%-0.2% of total healthcare budget), financial payoffs were delayed
(by 9-14 years) and impact on incident cases of diabetes was limited
(0.1%-1.6%?reduction). There was insufficient evidence to answer the question of
(1) whether lifestyle programmes are more cost effective than metformin or (2)
whether low-intensity lifestyle interventions are more cost effective than the
more intensive lifestyle programmes that were tested in trials. CONCLUSIONS: The
economics of preventing diabetes are complex. There is some evidence that
diabetes prevention programmes are cost effective, but the evidence base to date
provides few clear answers regarding design of prevention programmes because of
differences in denominator populations, definitions, interventions and modelling
assumptions.
|*Life Style
[MESH]
|Cost-Benefit Analysis
[MESH]
|Diabetes Mellitus, Type 2/*economics/*prevention & control
[MESH]