Preventing Chronic Disease: September 2010: 09_0200

ORIGINAL RESEARCH
Cost-Effectiveness Analysis of Efforts to Reduce Risk of Type 2 Diabetes and Cardiovascular Disease in Southwestern Pennsylvania, 2005-2007
Kenneth J. Smith, MD, MSc; Heather E. Hsu, MPH; Mark S. Roberts, MD, MPP; M. Kaye Kramer, DrPH, BSN; Trevor J. Orchard, MD; Gretchen A. Piatt, PhD; Miriam C. Seidel, MS, RD; Janice C. Zgibor, PhD; Cindy L. Bryce, PhD

Suggested citation for this article: Smith KJ, Hsu HE, Roberts MS, Kramer MK, Orchard TJ, Piatt GA, et al. Cost-effectiveness analysis of efforts to reduce risk of type 2 diabetes and cardiovascular disease in southwestern Pennsylvania, 2005-2007. Prev Chronic Dis 2010;7(5). http://www.cdc.gov/pcd/issues/2010/sep/09_0200.htm. Accessed [date].

PEER REVIEWED

Abstract
Introduction
We assessed the cost-effectiveness of a community-based, modified Diabetes Prevention Program (DPP) designed to reduce risk factors for type 2 diabetes and cardiovascular disease.

Methods
We developed a Markov decision model to compare costs and effectiveness of a modified DPP intervention with usual care during a 3-year period. Input parameters included costs and outcomes from 2 projects that implemented a community-based modified DPP for participants with metabolic syndrome, and from other sources. The model discounted future costs and benefits by 3% annually.

Results
At 12 months, usual care reduced relative risk of metabolic syndrome by 12.1%. A modified DPP intervention reduced relative risk by 16.2% and yielded life expectancy gains of 0.01 quality-adjusted life-years (3.67 days) at an incremental cost of $34.50 ($3,420 per quality-adjusted life-year gained). In 1-way sensitivity analyses, results were sensitive to probabilities that risk factors would be reduced with or without a modified DPP and that patients would enroll in an intervention, undergo testing, and acquire diabetes with or without an intervention if they were risk-factor–positive. Results were also sensitive to utilities for risk-factor–positive patients. In probabilistic sensitivity analysis, the intervention cost less than $20,000 per quality-adjusted life-year gained in approximately 78% of model iterations.

Conclusion
We consider the modified DPP delivered in community and primary care settings a sound investment.

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Preventing Chronic Disease: September 2010: 09_0200