Lifestyle Interventions to Prevent Type 2 Diabetes: A Systematic Review of Economic Evaluation Studies

Table 2

Economic evaluation details of studies.

Study	Currency, discount rate	Perspective	Costs	Effectiveness; measure	Incremental cost-effectiveness ratio	Is intervention cost-effective? (benchmark)
For diabetes preventions
Herman et al. [16], 2012	US$, 2010, 3%	Health system and societal	Direct medical and nonmedical costs + intervention costs	QALYs	Lifestyle compared to placebo, health system perspective: 12,878$US/QALY; societal perspective: 23,597$US/QALY	Yes
Herman et al. [17], 2013	US$, 2010, 3%	Health system and societal	Direct medical and nonmedical costs + intervention costs	QALYs	(a) Health system perspective: cost saving (lifestyle versus placebo) cost saving (metformin versus placebo); (b) societal perspective: the ICER was 3,235$US/QALY (lifestyle versus placebo)	Yes
van Wier et al. [18], 2013	Euros, 2008	Societal	Intervention costs + productivity lost costs	QALYs, 9-year risk of developing T2D	−50,273€/QALY gained; the ICER of 9-year risk for developing T2D was −1416€ Lifestyle guidance offered by practice nurses was not more effective in reducing these risks than the provision of general health brochures	No
Sagarra et al. [19], 2014	Euros, 2007	Health system	Intervention costs	Diabetes cases prevented and QALYs	376.17€/case of T2D averted; 3243€/QALY gained	Yes
Kolu et al. [20], 2013	Euros, 2009	Societal	Direct medical costs + lost productivity costs + health care intervention costs	Health perceptions (visual analog scale), birth weight, 15D (quality of life)	Each gram of birth weight prevented requires an additional cost of €7; each perceived health gain requires additional cost of 1697€	No
Oostdam et al. [21], 2012	Euros, 2009	Societal	Direct and indirect costs	Maternal fasting blood glucose, QALYs gained, infant birth weight, and insulin sensitivity	Being not cost-effective versus control group for blood glucose, insulin sensitivity, infant birth weight, and QALYs gained	No
Liu et al. [22], 2013	US$, 2007, 3%	Societal	Direct and nonmedical costs, indirect costs	QALYs	Savings: US$ 2017 per subject	Yes
Png et al. [23], 2014	US$, 2012, 3%	Health system and societal	Direct medical costs, direct nonmedical costs, and indirect costs	QALYs	Health system perspective: US$ 17,184/QALY for lifestyle modification versus placebo; societal perspective: US$ 36,367/QALY	Yes (WHO benchmark)
Bertram et al. [24], 2010	AU$, 2010, 3%	Health system	Directs cost of each intervention	DALYs averted, diabetes cases averted	AU$ 23.000/DALY averted (diet and exercise); AU$ 22.000/DALY averted (metformin)	Yes
Mortaz et al. [25], 2012	CAN$, 2010, 3%	Health system	Direct cost per person	QALYs	Conventional screening every 3 years was more effective over no screening	Yes
Johansson et al. [26], 2009	Krona, 2004, 3%	Societal	The societal costs	QALYs	For women QALY losses were lower and cost increases were lower; among men, the net costs were larger and QALYs lost were higher in all three treatments than in controls	Yes for women, No for men
Neumann et al. [27], 2011	Euros, 2007, 3%	Societal	Direct cost + interventions cost	QALYs	The ICERs were negative, for men and women who started the intervention when aged 30–50 years	Yes
Palmer and Tucker [28], 2012	AU$, 2009, 5%	Third-party payer and health system	Direct medical costs + intervention costs	QALYs	Intensive lifestyle change was cost-effective compared to controls	Yes
Smith et al. [29], 2010	US$, 2000, 3%	Societal	Direct costs + interventions costs	QALYs	$ 3,420/QALY due to decrease in diabetes incidence with intervention	Yes
For obesity control
Tsai et al. [30], 2013	US$, 2010	Health system	Intervention costs + health care providers + medication	QALYs	$US 3134/QALY (BLC compared to usual care); $US 115397/QALY (EBLC compared to routine care)	Yes
Cobiac et al. [31], 2010	US$, 2003, 3%	Health system	Direct and intervention costs	DALYs averted	Both weight loss programmes produced small improvements in the exposed subjects compared to current practices	No
Miners et al. [32], 2012	£UK, 2009, 3,5%	Health system	Direct and intervention costs	QALYs	The lowest was 102,000£/QALY; however, scenario contains women associated with lower QALYs compared with men	No
Forster et al. [33], 2011	AUS$, 2003, 3%	Health system	The intervention + direct costs related to each state in the model	DALYs averted	AUS$ 12000/DALY averted (DASH diet) AUS$ 13000/DALY averted (low fat diet)	Yes
Lewis et al. [34], 2014	£UK, 2012, 3,5%	Health system	Intervention costs	QALYs	For subjects with BMI ≥30, lighter life is cost-effective; for subjects with BMI ≥40 eligible for bariatric surgery, gastric bypass is cost-effective	Yes
Anokye et al. [35], 2011	£UK, 2011, 3,5%	Third-party payer	Direct costs + intervention costs	QALYs	20,876£/QALY	Yes

BLC: brief lifestyle counselling; DALY: Disability Adjusted Life Year; DASH: dietary approach to stop hypertension; EBLC: enhanced brief lifestyle counselling; ICER: incremental cost-effectiveness ratio; MetS: metabolic syndrome; QALY: Quality Adjusted Life Year; VAS: visual analog scale; 15D: 15-Dimension.
According to authors conclusions about the value of one or more interventions to control obesity or prevent type 2 diabetes. One study used WHO benchmark to justify the conclusion as mentioned in bracket.