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Walsh S, Brain J, Mukadam N, Anderson R, Greene L, Govia I, Kuhn I, Anstey KJ, Knapp M, Stephan BCM, Brayne C. A systematic review of the cost-effectiveness of community and population interventions to reduce the modifiable risk factors for dementia. Maturitas 2022; 166:104-116. [PMID: 36150253 DOI: 10.1016/j.maturitas.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/03/2022] [Accepted: 09/04/2022] [Indexed: 10/14/2022]
Abstract
Dementia is a leading global cause of morbidity and mortality. Evidence suggests that tackling modifiable lifecourse risk factors could prevent or delay a significant proportion of cases. Population- and community-based approaches change societal conditions such that everyone across a given community is more likely to live more healthily. We systematically reviewed economic studies of population- and community-based interventions to reduce modifiable lifecourse risk factors for dementia. We searched Medline, EMBASE, Web of Science, CINAHL, PsycInfo, Scopus, Econlit, ERIC, the British Education Index, and Google, on 03/03/2022. We included cost-effectiveness, cost-benefit, and cost-utility studies, provided that the direct outcome of the intervention was a modifiable risk factor for dementia, and was measured empirically. Quality appraisal was completed using the Consensus on Health Economic Criteria checklist. A narrative synthesis was performed. We included 45 studies, from 22,749 records identified. Included studies targeted smoking (n = 15), education (n = 10), physical inactivity (n = 9), obesity (n = 5), air pollution (n = 2), traumatic brain injury (n = 1), and multiple risk factors (n = 3). Intervention designs included changing the physical/food environment (n = 13), mass media programmes (n = 11), reducing financial barriers or increasing resources (n = 10), whole-community approaches (n = 6), and legislative change (n = 3). Overall, interventions were highly cost-effective and/or cost-saving, particularly those targeting smoking, educational attainment, and physical inactivity. Effects were observed in high- (e.g. USA and UK) and low- and middle-income (e.g. Mexico, Tanzania, Thailand) countries. Further research into the direct effects of targeting these risk factors on future dementia prevalence will have important economic, social and policy implications.
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Affiliation(s)
- Sebastian Walsh
- Cambridge Public Health, University of Public Health, Robinson Way, Cambridge CB2 0SR, United Kingdom of Great Britain and Northern Ireland.
| | - Jacob Brain
- Institute of Mental Health, Jubilee Campus, University of Nottingham Innovation Park, Triumph Road, Nottingham NG7 2TU, United Kingdom of Great Britain and Northern Ireland
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, Maple House, London W1T 7BN, United Kingdom of Great Britain and Northern Ireland
| | - Robert Anderson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, United Kingdom of Great Britain and Northern Ireland
| | - Leanne Greene
- College of Medicine and Health, University of Exeter, Exeter EX1 2HZ, United Kingdom of Great Britain and Northern Ireland
| | - Ishtar Govia
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - Isla Kuhn
- University of Cambridge Medical School Library, School of Clinical Medicine, Cambridge CB2 0SP, United Kingdom of Great Britain and Northern Ireland
| | - Kaarin J Anstey
- UNSW Ageing Futures Institute, University of New South Wales, Kensington, Sydney 2033, Australia; Neuroscience Research Australia, 139 Barker Street, Randwick, NSW 2031, Australia
| | - Martin Knapp
- London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom of Great Britain and Northern Ireland
| | - Blossom C M Stephan
- Institute of Mental Health, Jubilee Campus, University of Nottingham Innovation Park, Triumph Road, Nottingham NG7 2TU, United Kingdom of Great Britain and Northern Ireland
| | - Carol Brayne
- Cambridge Public Health, University of Public Health, Robinson Way, Cambridge CB2 0SR, United Kingdom of Great Britain and Northern Ireland
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Röding D, Walter U, Dreier M. Long-Term Effects of Integrated Strategies of Community Health Promotion on Diabetes Mellitus Mortality: a Natural Policy Experiment Based on Aggregated Longitudinal Secondary Data. J Urban Health 2021; 98:791-800. [PMID: 34799821 PMCID: PMC8688653 DOI: 10.1007/s11524-021-00590-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 10/28/2022]
Abstract
Integrated strategies of community health promotion (ISCHP) are based on intersectoral collaborations using the Health in All Policies approach to address determinants of health. While effects on health determinants have been shown, evidence on the effectiveness of ISCHP on health outcomes is scarce. The aim of this study is to assess the long-term effects of ISCHP on diabetes mellitus mortality (DMM) in German communities. A nonrandomized evaluation based on secondary county-level official data (1998-2016) was performed. In April 2019, 149 communities in Germany with ISCHP out of 401 were identified. Communities with < 5 measurements of DMM, starting before 1999 or after 2015, were excluded. Analyses included 65 communities with ISCHP (IG) and 124 without ISCHP (CG). ISCHP ran for a mean of 5.6 years. Fixed effects (FE) models were used to estimate effects of ISCHP and duration on DMM taking into account the time-varying average age. The FE estimator for DMM is b = - 2.48 (95% CI - 3.45 to - 1.51) for IG vs. CG and b = - 0.30 (95% CI - 0.46 to - 0.14) for ISCHP duration (0-16 years). In the first year of an ISCHP, a reduction of the annual DMM of 0.3 per 100,000 population (1%), and in the 16th year of 4.8 (14%) was achieved. This study provides preliminary evidence of the effectiveness of ISCHP in Germany. Limitations include inaccuracies to classify IG and CG and possible selection bias. Longitudinal county-level data may be an efficient data source to evaluate complex interventions, thereby contributing to further strengthen evidence-based integrated health promotion.
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Affiliation(s)
- Dominik Röding
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
| | - Ulla Walter
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Maren Dreier
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg Str. 1, 30625, Hannover, Germany
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Li J, Sun L, Hou Y, Chen L. Cost-Effectiveness Analysis of a Mobile-Based Intervention for Patients with Type 2 Diabetes Mellitus. Int J Endocrinol 2021; 2021:8827629. [PMID: 34306072 PMCID: PMC8266460 DOI: 10.1155/2021/8827629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 04/10/2021] [Accepted: 06/04/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the cost effectiveness of a mobile-based intervention for patients with type 2 diabetes mellitus (T2DM) and compare it with the usual management mode. METHOD A total of 215 patients with T2DM in a tertiary-care hospital specific to diabetes were selected as the study population. This study was conducted from January 1, 2019 to January 1, 2020. Of the 215 patients, 130 were randomly assigned to the mHealth group and 85 were assigned to the usual care group. IBM SPSS 25.0 software was used for descriptive statistics, t tests, chi-square tests, and correlation analyses. Haemoglobin A1c (HbA1c) was the effectiveness parameter adopted. Cost-effectiveness analyses were performed, and incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS Of the 215 patients with T2DM, the proportion of male patients was 66.0%. The mean age of the patients was 47.2 (SD 9.95). Differences in baseline information were not statistically significant between the two groups (P > 0.05). At the 3-, 6-, and 12-month follow-ups, the mHealth group reported higher control rates of HbA1c than the usual care group, 67.9% versus 46.2% (P < 0.001), 72.4% versus 45.4% (P < 0.001), and 74.6% versus 47.1% (P < 0.001), respectively. The value of HbA1c was positively related to total patient cost, material fee, Western medicine fee, and hospitalization expenses (P < 0.05), with correlation coefficients of 0.202, 0.200, 0.172, and 0.183, respectively. The costs of the mHealth group and usual care group were CNY¥ 1169.76 and CNY¥ 1775.44 per patient/year, respectively. The incremental cost of the mHealth intervention was CNY¥ -605.68 per patient/year. The ICER was CNY¥ -22.02 per patient/year. CONCLUSION Compared with the usual care mode, the mHealth management model for patients with T2DM improved the control rate of HbA1c, and the mHealth management mode had better cost effectiveness.
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Affiliation(s)
- Jing Li
- National Health Commission Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, No 6, Huanruibei Road, Beichen District, Tianjin 300134, China
| | - Li Sun
- School of Nursing, Tianjin Medical University, Tianjin 300070, China
| | - Yabing Hou
- School of Public Health, Tianjin Medical University, No 22, Qixiangtai Road, Heping District, Tianjin 300070, China
| | - Liming Chen
- National Health Commission Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, No 6, Huanruibei Road, Beichen District, Tianjin 300134, China
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Bevan G, De Poli C, Keng MJ, Raine R. How valid are projections of the future prevalence of diabetes? Rapid reviews of prevalence-based and Markov chain models and comparisons of different models' projections for England. BMJ Open 2020; 10:e033483. [PMID: 32132137 PMCID: PMC7059487 DOI: 10.1136/bmjopen-2019-033483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To examine validity of prevalence-based models giving projections of prevalence of diabetes in adults, in England and the UK, and of Markov chain models giving estimates of economic impacts of interventions to prevent type 2 diabetes (T2D). METHODS Rapid reviews of both types of models. Estimation of the future prevalence of T2D in England by Markov chain models; and from the trend in the prevalence of diabetes, as reported in the Quality and Outcomes Framework (QOF), estimated by ordinary least squares regression analysis. SETTING Adult population in England and UK. MAIN OUTCOME MEASURE Prevalence of T2D in England and UK in 2025. RESULTS The prevalence-based models reviewed use sample estimates of past prevalence rates by age and sex and projected population changes. Three most recent models, including that of Public Health England (PHE), neither take account of increases in obesity, nor report Confidence Intervals (CIs). The Markov chain models reviewed use transition probabilities between states of risk and death, estimated from various sources. None of their accounts give the full matrix of transition probabilities, and only a minority report tests of validation. Their primary focus is on estimating the ratio of costs to benefits of preventive interventions in those with hyperglycaemia, only one reported estimates of those developing T2D in the absence of a preventive intervention in the general population.Projections of the prevalence of T2D in England in 2025 were (in millions) by PHE, 3.95; from the QOF trend, 4.91 and by two Markov chain models, based on our review, 5.64 and 9.07. CONCLUSIONS To inform national policies on preventing T2D, governments need validated models, designed to use available data, which estimate the scale of incidence of T2D and survival in the general population, with and without preventive interventions.
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Affiliation(s)
- Gwyn Bevan
- Department of Management, London School of Economics and Political Science, London, UK
| | - Chiara De Poli
- Department of Management, London School of Economics and Political Science, London, UK
| | - Mi Jun Keng
- Department of Management, London School of Economics and Political Science, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
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Sakane N. Diabetes prevention in the real world: Insights from the JDPP and J-DOIT1. J Gen Fam Med 2017; 18:325-330. [PMID: 29264060 PMCID: PMC5729318 DOI: 10.1002/jgf2.85] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 12/12/2016] [Indexed: 11/07/2022] Open
Abstract
Type 2 diabetes (T2D) is associated with increased risks of morbidity and mortality. Diabetes prevention is an urgent issue in Japan. The Finnish Diabetes Prevention Study and US Diabetes Prevention Program revealed that intensive lifestyle intervention can prevent or delay the development of T2D in high-risk populations. Translational research varies in hospitals, primary care, communities, the workplace, and other settings. Translational research is feasible but less effective. There have been no long-term follow-ups. The outcome of the studies was mainly weight changes. The Japan Diabetes Prevention Program (JDPP) is a trial to test the efficacy of a lifestyle intervention program, which carried out in a primary healthcare setting using existing resources. The Japan Diabetes Outcome Trial-1 (J-DOIT1) is a nationwide telephone-delivered lifestyle intervention in a real-world setting. This review will focus on the effectiveness of a diabetes prevention program (recruitment, target population, method of intervention, and evaluation) in the real world and insights from the JDPP and J-DOIT1.
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Affiliation(s)
- Naoki Sakane
- Division of Preventive Medicine Clinical Research Institute National Hospital Organization Kyoto Medical Center Kyoto Japan
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Neumann A, Lindholm L, Norberg M, Schoffer O, Klug SJ, Norström F. The cost-effectiveness of interventions targeting lifestyle change for the prevention of diabetes in a Swedish primary care and community based prevention program. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:905-919. [PMID: 27913943 PMCID: PMC5533851 DOI: 10.1007/s10198-016-0851-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 11/21/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND Policymakers need to know the cost-effectiveness of interventions to prevent type 2 diabetes (T2D). The objective of this study was to estimate the cost-effectiveness of a T2D prevention initiative targeting weight reduction, increased physical activity and healthier diet in persons in pre-diabetic states by comparing a hypothetical intervention versus no intervention in a Swedish setting. METHODS A Markov model was used to study the cost-effectiveness of a T2D prevention program based on lifestyle change versus a control group where no prevention was applied. Analyses were done deterministically and probabilistically based on Monte Carlo simulation for six different scenarios defined by sex and age groups (30, 50, 70 years). Cost and quality adjusted life year (QALY) differences between no intervention and intervention and incremental cost-effectiveness ratios (ICERs) were estimated and visualized in cost-effectiveness planes (CE planes) and cost-effectiveness acceptability curves (CEA curves). RESULTS All ICERs were cost-effective and ranged from 3833 €/QALY gained (women, 30 years) to 9215 €/QALY gained (men, 70 years). The CEA curves showed that the probability of the intervention being cost-effective at the threshold value of 50,000 € per QALY gained was very high for all scenarios ranging from 85.0 to 91.1%. DISCUSSION/CONCLUSION The prevention or the delay of the onset of T2D is feasible and cost-effective. A small investment in healthy lifestyle with change in physical activity and diet together with weight loss are very likely to be cost-effective.
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Affiliation(s)
- Anne Neumann
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
- Center of Evidence-Based Healthcare, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Lars Lindholm
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Margareta Norberg
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Olaf Schoffer
- Cancer Epidemiology, University Cancer Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Stefanie J Klug
- Cancer Epidemiology, University Cancer Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Fredrik Norström
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
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Hollenbeak CS, Weinstock RS, Cibula D, Delahanty LM, Trief PM. Cost-effectiveness of SHINE: A Telephone Translation of the Diabetes Prevention Program. Health Serv Insights 2016; 9:21-8. [PMID: 27429556 PMCID: PMC4936790 DOI: 10.4137/hsi.s39084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/17/2016] [Accepted: 04/24/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The Support, Health Information, Nutrition, and Exercise (SHINE) trial recently showed that a telephone adaptation of the Diabetes Prevention Program (DPP) lifestyle intervention was effective in reducing weight among patients with metabolic syndrome. The aim of this study is to determine whether a conference call (CC) adaptation was cost effective relative to an individual call (IC) adaptation of the DPP lifestyle intervention in the primary care setting. METHODS We performed a stochastic cost-effectiveness analysis alongside a clinical trial comparing two telephone adaptations of the DPP lifestyle intervention. The primary outcomes were incremental cost-effectiveness ratios estimated for weight loss, body mass index (BMI), waist circumference, and quality-adjusted life years (QALYs). Costs were estimated from the perspective of society and included direct medical costs, indirect costs, and intervention costs. RESULTS After one year, participants receiving the CC intervention accumulated fewer costs ($2,831 vs. $2,933) than the IC group, lost more weight (6.2 kg vs. 5.1 kg), had greater reduction in BMI (2.1 vs. 1.9), and had greater reduction in waist circumference (6.5 cm vs. 5.9 cm). However, participants in the CC group had fewer QALYs than those in the IC group (0.635 vs. 0.646). The incremental cost-effectiveness ratio for CC vs. IC was $9,250/QALY, with a 48% probability of being cost-effective at a willingness-to-pay of $100,000/QALY. CONCLUSIONS CC delivery of the DPP was cost effective relative to IC delivery in the first year in terms of cost per clinical measure (weight lost, BMI, and waist circumference) but not in terms of cost per QALY, most likely because of the short time horizon.
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Affiliation(s)
- Christopher S Hollenbeak
- Departments of Surgery and Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Ruth S Weinstock
- Departments of Medicine, and Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Donald Cibula
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Linda M Delahanty
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Paula M Trief
- Departments of Medicine, Psychiatry and Behavioral Sciences, and Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
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Briggs ADM, Wolstenholme J, Blakely T, Scarborough P. Choosing an epidemiological model structure for the economic evaluation of non-communicable disease public health interventions. Popul Health Metr 2016; 14:17. [PMID: 27152092 PMCID: PMC4857239 DOI: 10.1186/s12963-016-0085-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 04/20/2016] [Indexed: 11/10/2022] Open
Abstract
Non-communicable diseases are the leading global causes of mortality and morbidity. Growing pressures on health services and on social care have led to increasing calls for a greater emphasis to be placed on prevention. In order for decisionmakers to make informed judgements about how to best spend finite public health resources, they must be able to quantify the anticipated costs, benefits, and opportunity costs of each prevention option available. This review presents a taxonomy of epidemiological model structures and applies it to the economic evaluation of public health interventions for non-communicable diseases. Through a novel discussion of the pros and cons of model structures and examples of their application to public health interventions, it suggests that individual-level models may be better than population-level models for estimating the effects of population heterogeneity. Furthermore, model structures allowing for interactions between populations, their environment, and time are often better suited to complex multifaceted interventions. Other influences on the choice of model structure include time and available resources, and the availability and relevance of previously developed models. This review will help guide modelers in the emerging field of public health economic modeling of non-communicable diseases.
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Affiliation(s)
- Adam D. M. Briggs
- />BHF Centre on Population Approaches for Non-Communicable Disease Prevention (BHF CPNP), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Jane Wolstenholme
- />Health Economics Research Centre (HERC), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tony Blakely
- />Health Inequalities Research Programme (HIRP), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Peter Scarborough
- />BHF Centre on Population Approaches for Non-Communicable Disease Prevention (BHF CPNP), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
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Alouki K, Delisle H, Bermúdez-Tamayo C, Johri M. Lifestyle Interventions to Prevent Type 2 Diabetes: A Systematic Review of Economic Evaluation Studies. J Diabetes Res 2016; 2016:2159890. [PMID: 26885527 PMCID: PMC4738686 DOI: 10.1155/2016/2159890] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/13/2015] [Accepted: 10/19/2015] [Indexed: 01/29/2023] Open
Abstract
Objective. To summarize key findings of economic evaluations of lifestyle interventions for the primary prevention of type 2 diabetes (T2D) in high-risk subjects. Methods. We conducted a systematic review of peer-reviewed original studies published since January 2009 in English, French, and Spanish. Eligible studies were identified through relevant databases including PubMed, Medline, National Health Services Economic Evaluation, CINHAL, EconLit, Web of sciences, EMBASE, and the Latin American and Caribbean Health Sciences Literature. Studies targeting obesity were also included. Data were extracted using a standardized method. The BMJ checklist was used to assess study quality. The heterogeneity of lifestyle interventions precluded a meta-analysis. Results. Overall, 20 studies were retained, including six focusing on obesity control. Seven were conducted within trials and 13 using modeling techniques. T2D prevention by physical activity or diet or both proved cost-effective according to accepted thresholds, except for five inconclusive studies, three on diabetes prevention and two on obesity control. Most studies exhibited limitations in reporting results, primarily with regard to generalizability and justification of selected sensitivity parameters. Conclusion. This confirms that lifestyle interventions for the primary prevention of diabetes are cost-effective. Such interventions should be further promoted as sound investment in the fight against diabetes.
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Affiliation(s)
- Koffi Alouki
- TRANSNUT, WHO Collaborating Centre on Nutrition Changes and Development, Department of Nutrition, Faculty of Medicine, University of Montreal, 2405 Chemin de la Côte Sainte-Catherine, Montreal, QC, Canada H3T 1A8
| | - Hélène Delisle
- TRANSNUT, WHO Collaborating Centre on Nutrition Changes and Development, Department of Nutrition, Faculty of Medicine, University of Montreal, 2405 Chemin de la Côte Sainte-Catherine, Montreal, QC, Canada H3T 1A8
- *Hélène Delisle:
| | - Clara Bermúdez-Tamayo
- Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), University of Montreal, 7101 Avenue du Parc, 3e Étage, Montréal, QC, Canada H3N 1X9
| | - Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, 850 Rue Saint-Denis, Montréal, QC, Canada H2X 0A9
- Department of Health Administration, School of Public Health (ESPUM), Faculty of Medicine, University of Montreal, 7101 Avenue du Parc, 3e Étage, Montréal, QC, Canada H3N 1X9
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Watson P, Preston L, Squires H, Chilcott J, Brennan A. Modelling the economics of type 2 diabetes mellitus prevention: a literature review of methods. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:239-253. [PMID: 24595522 DOI: 10.1007/s40258-014-0091-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Our objective was to review modelling methods for type 2 diabetes mellitus prevention cost-effectiveness studies. The review was conducted to inform the design of a policy analysis model capable of assisting resource allocation decisions across a spectrum of prevention strategies. We identified recent systematic reviews of economic evaluations in diabetes prevention and management of obesity. We extracted studies from two existing systematic reviews of economic evaluations for the prevention of diabetes. We extracted studies evaluating interventions in a non-diabetic population with type 2 diabetes as a modelled outcome, from two systematic reviews of obesity intervention economic evaluations. Databases were searched for studies published between 2008 and 2013. For each study, we reviewed details of the model type, structure, and methods for predicting diabetes and cardiovascular disease. Our review identified 46 articles and found variation in modelling approaches for cost-effectiveness evaluations for the prevention of type 2 diabetes. Investigation of the variables used to estimate the risk of type 2 diabetes suggested that impaired glucose regulation, and body mass index were used as the primary risk factors for type 2 diabetes. A minority of cost-effectiveness models for diabetes prevention accounted for the multivariate impacts of interventions on risk factors for type 2 diabetes. Twenty-eight cost-effectiveness models included cardiovascular events in addition to type 2 diabetes. Few cost-effectiveness models have flexibility to evaluate different intervention types. We conclude that to compare a range of prevention interventions it is necessary to incorporate multiple risk factors for diabetes, diabetes-related complications and obesity-related co-morbidity outcomes.
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Affiliation(s)
- P Watson
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK,
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Saha S, Carlsson KS, Gerdtham UG, Eriksson MK, Hagberg L, Eliasson M, Johansson P. Are lifestyle interventions in primary care cost-effective?--An analysis based on a Markov model, differences-in-differences approach and the Swedish Björknäs study. PLoS One 2013; 8:e80672. [PMID: 24244703 PMCID: PMC3828270 DOI: 10.1371/journal.pone.0080672] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 10/07/2013] [Indexed: 01/23/2023] Open
Abstract
Background Lifestyle interventions affect patients’ risk factors for metabolic syndrome (MeSy), a pre-stage to cardiovascular diseases, diabetes and related complications. An effective lifestyle intervention is the Swedish Björknäs intervention, a 3-year randomized controlled trial in primary care for MeSy patients. To include future disease-related cost and health consequences in a cost-effectiveness analysis, a simulation model was used to estimate the short-term (3-year) and long-term (lifelong) cost-effectiveness of the Björknäs study. Methodology/ Principal Findings A Markov micro-simulation model was used to predict the cost and quality-adjusted life years (QALYs) for MeSy-related diseases based on ten risk factors. Model inputs were levels of individual risk factors at baseline and at the third year. The model estimated short-term and long-term costs and QALYs for the intervention and control groups. The cost-effectiveness of the intervention was assessed using differences-in-differences approach to compare the changes between the groups in the health care and societal perspectives, using a 3% discount rate. A 95% confidence interval (CI), based on bootstrapping, and sensitivity analyses describe the uncertainty in the estimates. In the short-term, costs are predicted to increase over time in both groups, but less in the intervention group, resulting in an average cost saving/reduction of US$-700 (in 2012, US$1=six point five seven SEK) and US$-500, in the societal and health care perspectives. The long-term estimate also predicts increased costs, but considerably less in the intervention group: US$-7,300 (95% CI: US$-19,700 to US$-1,000) in the societal, and US$-1,500 (95% CI: US$-5,400 to US$2,650) in the health care perspective. As intervention costs were US$211 per participant, the intervention would result in cost saving. Furthermore, in the long-term an estimated 0.46 QALYs (95% CI: 0.12 to 0.69) per participant would be gained. Conclusions/ Significance The Swedish Björknäs study appears to reduce demands on societal and health care resources and increase health-related quality of life.
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Affiliation(s)
- Sanjib Saha
- Centre for Primary Healthcare Research, Skåne University Hospital, Malmö, Lund University/Region Skåne, Malmö, Sweden
- Health Economics and Management, Institute of Economic Research, Lund University, Lund, Sweden
- * E-mail:
| | - Katarina Steen Carlsson
- Centre for Primary Healthcare Research, Skåne University Hospital, Malmö, Lund University/Region Skåne, Malmö, Sweden
| | - Ulf-G Gerdtham
- Centre for Primary Healthcare Research, Skåne University Hospital, Malmö, Lund University/Region Skåne, Malmö, Sweden
- Health Economics and Management, Institute of Economic Research, Lund University, Lund, Sweden
- Economics Department, Lund University, Lund, Sweden
| | - Margareta K. Eriksson
- Department of Public Health and Department of Research, Norrbotten County Council, Luleå, Sweden
- Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Lars Hagberg
- Centre for Healthcare Science, Örebro County Council and Örebro University, Örebro, Sweden
| | - Mats Eliasson
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Pia Johansson
- Centre for Health Economics, Informatics and Healthcare Research, Stockholm County Council, Stockholm, Sweden
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Chatterjee R, Narayan KMV, Lipscomb J, Jackson SL, Long Q, Zhu M, Phillips LS. Screening for diabetes and prediabetes should be cost-saving in patients at high risk. Diabetes Care 2013; 36:1981-7. [PMID: 23393215 PMCID: PMC3687271 DOI: 10.2337/dc12-1752] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 12/16/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Although screening for diabetes and prediabetes is recommended, it is not clear how best or whom to screen. We therefore compared the economics of screening according to baseline risk. RESEARCH DESIGN AND METHODS Five screening tests were performed in 1,573 adults without known diabetes--random plasma/capillary glucose, plasma/capillary glucose 1 h after 50-g oral glucose (any time, without previous fast, plasma glucose 1 h after a 50-g oral glucose challenge [GCTpl]/capillary glucose 1 h after a 50-g oral glucose challenge [GCTcap]), and A1C--and a definitive 75-g oral glucose tolerance test. Costs of screening included the following: costs of testing (screen plus oral glucose tolerance test, if screen is positive); costs for false-negative results; and costs of treatment of true-positive results with metformin, all over the course of 3 years. We compared costs for no screening, screening everyone for diabetes or high-risk prediabetes, and screening those with risk factors based on age, BMI, blood pressure, waist circumference, lipids, or family history of diabetes. RESULTS Compared with no screening, cost-savings would be obtained largely from screening those at higher risk, including those with BMI >35 kg/m(2), systolic blood pressure ≥130 mmHg, or age >55 years, with differences of up to -46% of health system costs for screening for diabetes and -21% for screening for dysglycemia110, respectively (all P < 0.01). GCTpl would be the least expensive screening test for most high-risk groups for this population over the course of 3 years. CONCLUSIONS From a health economics perspective, screening for diabetes and high-risk prediabetes should target patients at higher risk, particularly those with BMI >35 kg/m(2), systolic blood pressure ≥130 mmHg, or age >55 years, for whom screening can be most cost-saving. GCTpl is generally the least expensive test in high-risk groups and should be considered for routine use as an opportunistic screen in these groups.
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Affiliation(s)
- Ranee Chatterjee
- Department of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
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Kraushaar LE, Krämer A. Web-Enabled Feedback Control Over Energy Balance Promotes an Increase in Physical Activity and a Reduction of Body Weight and Disease Risk in Overweight Sedentary Adults. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2013; 15:579-87. [DOI: 10.1007/s11121-013-0398-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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14
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Weintraub WS, Daniels SR, Burke LE, Franklin BA, Goff DC, Hayman LL, Lloyd-Jones D, Pandey DK, Sanchez EJ, Schram AP, Whitsel LP. Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association. Circulation 2011; 124:967-90. [PMID: 21788592 DOI: 10.1161/cir.0b013e3182285a81] [Citation(s) in RCA: 404] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The process of atherosclerosis may begin in youth and continue for decades, leading to both nonfatal and fatal cardiovascular events, including myocardial infarction, stroke, and sudden death. With primordial and primary prevention, cardiovascular disease is largely preventable. Clinical trial evidence has shown convincingly that pharmacological treatment of risk factors can prevent events. The data are less definitive but also highly suggestive that appropriate public policy and lifestyle interventions aimed at eliminating tobacco use, limiting salt consumption, encouraging physical exercise, and improving diet can prevent events. There has been concern about whether efforts aimed at primordial and primary prevention provide value (ie, whether such interventions are worth what we pay for them). Although questions about the value of therapeutics for acute disease may be addressed by cost-effectiveness analysis, the long time frames involved in evaluating preventive interventions make cost-effectiveness analysis difficult and necessarily flawed. Nonetheless, cost-effectiveness analyses reviewed in this policy statement largely suggest that public policy, community efforts, and pharmacological intervention are all likely to be cost-effective and often cost saving compared with common benchmarks. The high direct medical care and indirect costs of cardiovascular disease-approaching $450 billion a year in 2010 and projected to rise to over $1 trillion a year by 2030-make this a critical medical and societal issue. Prevention of cardiovascular disease will also provide great value in developing a healthier, more productive society.
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Johansson P, Tillgren P. Financing intersectoral health promotion programmes: Some reasons why collaborators are collaborating as indicated by cost-effectiveness analyses. Scand J Public Health 2011; 39:26-32. [DOI: 10.1177/1403494810393559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: Intersectoral collaboration is an important part of many health promotion programmes. The reasons for the local organisations to collaborate, i.e. to finance programmes, are presumably based on benefits they derive from the collaboration. The aim of this study is to discuss whether subsector financial analyses based on data from cost-effectiveness analyses reflect incentives of collaborating organisations in two intersectoral health promotion programmes. Methods: Within economics, financial incentives are important reasons for actions. The financial incentives of collaborators are exemplified with two subsector financial analyses containing avoided disease-related costs as estimated in two cost-effectiveness analyses, on an elderly safety promotion programme (Safe Seniors in Sundbyberg) and on a diabetes prevention programme (Stockholm Diabetes Prevention Program, SDPP) from Stockholm, Sweden. Results: The subsector financial analyses indicate that there are financial incentives for the key local community organisation, i.e. the local authority, to collaborate in one of the programmes but not the other. There are no financial benefits for other important community organisations, such as non-governmental organisations. Conclusions: The reasons for collaborating organisations to collaborate within intersectoral health promotion programmes extend beyond financial benefits from averted disease. Thus, the reported subsector financial analyses are only partial reflections of the incentives of collaborators, but they might be used as a starting point for discussions on cost sharing among potential intersectoral collaborators.
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Affiliation(s)
- Pia Johansson
- Department of Public Health Sciences, Karolinska Institutet,
Stockholm, Sweden,
| | - Per Tillgren
- Department of Public Health Sciences, Karolinska Institutet,
Stockholm, Sweden, School of Health, Care and Social Welfare, Mälardalen
University, Västerås, Sweden
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