| Title |
Economic evaluation of type 2 diabetes prevention programmes: Markov model of low- and high-intensity lifestyle programmes and metformin in participants with different categories of intermediate hyperglycaemia
|
|---|---|
| Published in |
BMC Medicine, January 2018
|
| DOI | 10.1186/s12916-017-0984-4 |
| Pubmed ID | |
| Authors |
Samantha Roberts, Dawn Craig, Amanda Adler, Klim McPherson, Trisha Greenhalgh |
| Abstract |
National guidance on preventing type 2 diabetes mellitus (T2DM) in the UK recommends low-intensity lifestyle interventions for individuals with intermediate categories of hyperglycaemia defined in terms of impaired fasting glucose (IFG) or 'at-risk' levels of HbA1c. In a recent systematic review of economic evaluations of such interventions, most studies had evaluated intensive trial-based lifestyle programmes in participants with impaired glucose tolerance (IGT). This study examines the costs and effects of different intensity lifestyle programmes and metformin in participants with different categories of intermediate hyperglycaemia. We developed a decision tree and Markov model (50-year horizon) to compare four approaches, namely (1) a low-intensity lifestyle programme based on current NICE guidance, (2) a high-intensity lifestyle programme based on the US Diabetes Prevention Program, (3) metformin, and (4) no intervention, modelled for three different types of intermediate hyperglycaemia (IFG, IGT and HbA1c). A health system perspective was adopted and incremental analysis undertaken at an individual and population-wide level, taking England as a case study. Low-intensity lifestyle programmes were the most cost-effective (£44/QALY, £195/QALY and £186/QALY compared to no intervention in IGT, IFG and HbA1c, respectively). Intensive lifestyle interventions were also cost-effective compared to no intervention (£2775/QALY, £6820/QALY and £7376/QALY, respectively, in IGT, IFG and HbA1c). Metformin was cost-effective relative to no intervention (£5224/QALY, £6842/QALY and £372/QALY in IGT, IFG and HbA1c, respectively), but was only cost-effective relative to other treatments in participants identified with HbA1c. At a willingness-to-pay threshold of £20,000/QALY, low- and high-intensity lifestyle programmes were cost-effective 98%, 99% and 98% and 81%, 81% and 71% of the time in IGT, IFG and HbA1c, respectively. An England-wide programme for 50-59 year olds could reduce T2DM incidence by < 3.5% over 50 years and would cost 0.2-5.2% of the current diabetes budget for 2-9 years. This analysis suggests that current English national policy of low-intensity lifestyle programmes in participants with IFG or HbA1c will be cost-effective and have the most favourable budget impact, but will prevent only a fraction of cases of T2DM. Additional approaches to prevention need to be investigated urgently. |
X Demographics
The data shown below were collected from the profiles of 123 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 45 | 37% |
| Australia | 10 | 8% |
| United States | 5 | 4% |
| Ireland | 4 | 3% |
| Canada | 3 | 2% |
| Spain | 2 | 2% |
| Zimbabwe | 1 | <1% |
| Norway | 1 | <1% |
| South Africa | 1 | <1% |
| Other | 5 | 4% |
| Unknown | 46 | 37% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 52 | 42% |
| Scientists | 42 | 34% |
| Practitioners (doctors, other healthcare professionals) | 26 | 21% |
| Science communicators (journalists, bloggers, editors) | 3 | 2% |
Mendeley readers
The data shown below were compiled from readership statistics for 161 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 161 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 33 | 20% |
| Student > Bachelor | 22 | 14% |
| Student > Ph. D. Student | 13 | 8% |
| Researcher | 12 | 7% |
| Other | 8 | 5% |
| Other | 29 | 18% |
| Unknown | 44 | 27% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 43 | 27% |
| Nursing and Health Professions | 18 | 11% |
| Pharmacology, Toxicology and Pharmaceutical Science | 9 | 6% |
| Sports and Recreations | 6 | 4% |
| Business, Management and Accounting | 5 | 3% |
| Other | 30 | 19% |
| Unknown | 50 | 31% |
Attention Score in Context
This research output has an Altmetric Attention Score of 82. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 27 October 2018.
All research outputs
#532,152
of 25,959,914 outputs
Outputs from BMC Medicine
#400
of 4,076 outputs
Outputs of similar age
#12,480
of 455,411 outputs
Outputs of similar age from BMC Medicine
#6
of 49 outputs
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