ADA: Metformin, lifestyle changes are cost-effective for diabetics
While it is no surprise that intense lifestyle interventions and metformin therapy can significantly reduce the development of type 2 diabetes compared with placebo, research has shown that it is also cost-effective, according to a study presented June 28 at the American Diabetes Association’s (ADA) 71st annual scientific sessions in San Diego.

“Type 2 diabetes is a large and growing clinical and public health problem within the U.S. and around the world,” said the study's co-investigator William H. Herman, MD, MPH, a professor of the department of internal medicine at the University of Michigan Health System in Ann Arbor, Mich., during a press briefing.

Results from the initial Diabetes Prevention Program in 2002, showed that lifestyle intervention reduced the development of type 2 diabetes by 58 percent, from 11 percent per year to nearly 5 percent per year. Likewise, metformin therapy reduced the development of diabetes by 31 percent.

To add to these impressive results, Herman and colleagues conducted an economic analysis to project the long-term economic outcomes of both intensive lifestyle intervention and metformin therapy compared to placebo. The cost analysis assessed the cost of intervention, costs of medical care outside of the intervention and quality of life.

During a press conference at ADA.11, Herman reported that over a 10-year span, the total direct intervention costs, as well as the costs of medical care outside the intervention, were an estimated $1,500 per participant for those randomized to receive lifestyle intervention compared with those who received placebo.

“We found that the intensive lifestyle intervention prevented diabetes and also found that it was associated with substantial improvements in health related quality of life compared to both metformin and placebo interventions,” Herman said.

The cost of the lifestyle intervention was about $12,000 per quality-adjusted life years (QALY) gained compared to placebo. In addition, Herman reported that the total direct medical costs for metformin intervention were less and the quality of life was better. “The metformin intervention both saved money and improved health outcomes compared to the placebo intervention,” Herman offered. “This is an intervention that should be widely adopted and implemented into practice.”

While the lifestyle interventions cost money, they did significantly improve health outcomes, Herman said.

Herman said that “only about one in 10 interventions or new treatments in health and medicine are cost saving.” Interventions such as prenatal care, pediatric immunizations,and influenza immunizations are interventions that are broadly applied with no question and each cost in the range of $10,000 to $50,000. Herman put metformin in this same category and said “our data would suggest that the metformin be offered and covered for patients at high-risk of developing diabetes.”

Herman compared the intensive lifestyle intervention to other interventions that cost in the range of $10,000 to $50,000 per QALY gained. These interventions include administering beta-blockers after MI, antihypertensive therapy and statin medications.

“So the $12,000 per QALYs gained puts lifestyle intervention in the same category as these types of interventions; however, it is more cost-effective than most of the other interventions already adopted within medicine,” he offered. For example, left ventricular assist devices cost between $500,000 and $1.4 million per QALY and are still used and covered in practice.”

Herman said that the costs were higher for lifestyle interventions because during the study this included the costs for lifestyle care managers, medication care mangers and any other resources necessary to implement these interventions. Lifestyle intervention included a 16-week core curriculum on a one-on-one basis, which also could have contributed to the high costs.

The researchers said that integrating lifestyle interventions as a group intervention could be less expensive and more effective because of the increased social support.

Herman said that in the past policymakers have been hesitant to cover lifestyle interventions because of the high costs associated with them. However, “these data suggest that these types of interventions can be implemented faithfully and in a cost-effective manner,” said Herman. “Lifestyle interventions can be fairly implemented with good results and without a large financial burden.

“In summary, our results show that compared to doing nothing, administering metformin is in fact cost-effective. In addition, the intensive lifestyle intervention through not saving dollars,  is extremely cost effective,” said Herman. “We conclude that health policy should support the adoption and implementation of metformin and lifestyle intervention for diabetes prevention.”