Optimizing Portfolios of Interventions for Type 2 Diabetes Prevention and Management

Abstract

Type 2 Diabetes Mellitus (T2DM), the epidemic of the 21st century, accounts for 4.6 million deaths globally and for 11% of the global health expenditure. Several different public health, primary preventive, and secondary interventions promise better health outcomes and cost savings. This paper proposes a mathematical model for T2DM that comprehends the interactions of multiple interventions, the influence of those interventions on the costs, clinical indicators and utilities of disease states, as well as population dynamics. We use the model to optimize portfolios of interventions for awareness and disease management programs for various stages of T2DM, and give insights on the different ways interventions can be beneficial. For instance, our findings suggest that the main benefit of primary prevention (in the form of awareness interventions) may shift from averting new cases to increasing screening rates under different objectives. Among other policy points, we demonstrate that an intervention which is found to be costly under the classical net present value perspective can indeed be cost-saving in the future. Thus, accounting for long-run demographics and the interaction of interventions may be a useful extension to traditional cost-utility analyses.