Department of Endocrinology, University of Michigan, Ann Arbor, MI, USA.
Am J Manag Care. 2013;19(3):194-202.
We report the 10-year effectiveness and within-trial cost-effectiveness of the Diabetes Prevention Program (DPP) and its Outcomes Study (DPPOS) interventions among participants who were adherent to the interventions.
DPP was a 3-year randomized clinical trial followed by 7 years of open-label modified intervention follow-up.
Data on resource utilization, cost, and quality of life were collected prospectively. Economic analyses were performed from health system and societal perspectives. Lifestyle adherence was defined as achieving and maintaining a 5% reduction in initial body weight, and metformin adherence as taking metformin at 80% of study visits.
The relative risk reduction was 49.4% among adherent lifestyle participants and 20.8% among adherent metformin participants compared with placebo. Over 10 years, the cumulative, undiscounted, per capita direct medical costs of the interventions, as implemented during the DPP, were greater for adherent lifestyle participants ($4810) than adherent metformin participants ($2934) or placebo ($768). Over 10 years, the cumulative, per capita non-interventionrelated direct medical costs were $4250 greater for placebo participants compared with adherent lifestyle participants and $3251 greater compared with adherent metformin participants. The cumulative quality-adjusted life-years (QALYs) accrued over 10 years were greater for lifestyle (6.80) than metformin (6.74) or placebo (6.67). Without discounting, from a modified societal perspective (excluding participant time) and a full societal perspective (including participant time), lifestyle cost < $5000 per QALY-gained and metformin was cost saving compared with placebo.
Over 10 years, lifestyle intervention and metformin were cost-effective or cost saving compared with placebo. These analyses confirm that lifestyle and metformin represent a good value for money.
我们报告了在遵守干预措施的参与者中，糖尿病预防计划（DPP）及其结果研究（DPPOS）干预措施的 10 年效果和试验内成本效益。
DPP 是一项为期 3 年的随机临床试验，随后进行了 7 年的开放标签改良干预随访。
前瞻性收集资源利用、成本和生活质量数据。经济分析从卫生系统和社会角度进行。生活方式依从性定义为实现并维持初始体重减轻 5%，二甲双胍依从性定义为在 80%的研究访视中服用二甲双胍。
与安慰剂相比，坚持生活方式的参与者的相对风险降低了 49.4%，坚持二甲双胍的参与者的相对风险降低了 20.8%。在 10 年内，在 DPP 期间实施的干预措施的累积、未贴现、人均直接医疗成本，对于坚持生活方式的参与者（$4810）高于坚持二甲双胍的参与者（$2934）或安慰剂（$768）。在 10 年内，与坚持生活方式的参与者相比，安慰剂参与者的非干预相关直接医疗成本累积增加了$4250，与坚持二甲双胍的参与者相比，增加了$3251。在 10 年内累积的质量调整生命年（QALY），生活方式（6.80）高于二甲双胍（6.74）或安慰剂（6.67）。不贴现，从改良的社会角度（不包括参与者时间）和完全的社会角度（包括参与者时间）来看，生活方式的成本<$5000 每获得一个 QALY，与安慰剂相比，二甲双胍具有成本效益。
在 10 年内，与安慰剂相比，生活方式干预和二甲双胍在成本效益或成本效益方面具有优势。这些分析证实，生活方式和二甲双胍代表了物有所值。
