Lifestyle intervention, metformin eased financial burden of diabetes in DPP

ADA 71st Scientific Sessions

SAN DIEGO — A cost-effectiveness analysis of the landmark Diabetes Prevention Program found that treatment with metformin reduced the costs of medical care and lifestyle intervention only increased costs by during a 10-year period compared with placebo.

Cost reductions included lower costs for inpatient and outpatient care and prescriptions.

According to William H. Herman, MD, MPH, these findings are important because it is rare for a health intervention to simultaneously improve health and save money.

Initial results from the DPP reported in 2002 showed that lifestyle intervention led to a 58% reduction in the development of diabetes, from about 11% per year to about 5% per year. Metformin was associated with a 31% reduction in diabetes development. Herman and colleagues used data from the DPP Outcomes Study, which followed DPP participants for another 7 years. They examined intervention costs as well as outside medical care costs and considered cost per quality-adjusted life-years for the intensive lifestyle intervention, metformin intervention and placebo groups. During the follow-up period, participants were offered a less-intensive lifestyle intervention and continuation of metformin, and the effectiveness of both decreased to 31% and 19%, respectively.

According to results of the new analysis, metformin saved $30 per person and lifestyle intervention cost $1,500 per person during the 10-year period, when reductions in costs of medical care were balanced against the costs of the interventions.

The researchers’ calculations also showed that the cumulative, undiscounted, per capita, direct medical costs were greater for the lifestyle ($4,600) and metformin ($2,300) interventions than for placebo ($800). For medical care unrelated to the intervention, these costs were greater for placebo ($27,200) when compared with the metformin ($25,400) and intensive lifestyle ($24,600) interventions. The total costs were slightly higher for lifestyle ($29,200) but lower for metformin ($27,840) than for placebo ($32,252).

These data translated to a total intervention cost of $12,000 per quality-adjusted life-year gained for lifestyle. In contrast, the combined costs of the metformin intervention were slightly less and quality of life was greater when compared with the placebo group, according to Herman.

“The important thing to remember is that only one in 10 new treatments is cost-saving … Data suggest that the metformin intervention is something that should be offered and covered [by health insurance] for all individuals at risk for type 2 diabetes,” Herman said at a press conference.

Herman said the total costs of the lifestyle intervention should not discount the intervention, as many widely accepted and applied interventions, such statins for secondary prevention of cardiovascular disease, cost between $10,000 and $50,000 per quality-adjusted life-year gained. Furthermore, he said physicians can tailor the intervention so that it costs less but does not differ significantly from the intensive lifestyle intervention used in the DPP.

Overall, Herman noted, these interventions compare favorably with other interventions in medicine and health insurance should consider covering their costs. In fact, he said, they are as important as prenatal care or pediatric immunizations.

“We showed that, compared with nothing, the metformin intervention is cost-saving for diabetes prevention and the intensive lifestyle intervention, though not cost-saving, is extremely cost-effective. [We] conclude that health policy should support adoption and implementation of these options for diabetes prevention,” Herman said. – by Melissa Foster

For more information:

• Herman WH. 0136-LBOR. Presented at: American Diabetes Association’s 71st Scientific Sessions; June 24-28, 2011; San Diego, Calif.

Disclosure: Dr. Herman reports receiving consulting fees from McKinsey & Co.

The results we heard today really are newsworthy because they place the proven interventions to prevent type 2 diabetes into an economic framework that makes them favorable for consideration of altering policy to pay for prevention by the US health care system. In particular, treatment with the drug metformin was shown to be cost-saving, which is unusual for drug interventions to prevent any common disease that we take care of today. In addition, the lifestyle intervention is very effective. It has a stronger effect than most of the treatments that we offer to prevent heart attacks and strokes, and is clearly affordable in the framework of other interventions that we commonly pay for. For practicing physicians, this should really prompt reconsideration of physician practices to detect people at risk to develop diabetes and to prompt a more aggressive approach using metformin or lifestyle to prevent diabetes.

– James Meigs, MD

Type 2 diabetes epidemiology and prevention researcher
Primary care physician
Massachusetts General Hospital

Disclosure: Dr. Meigs reports no financial disclosures.