PDB21 The Lifetime Cost-Effectiveness of Lifestyle Intervention or Metformin for Prevention of Diabetes Mellitus Type 2 in Obese Adults with Prediabetes from the Mexican Healthcare Perspective

Abstract

Lifestyle interventions and metformin have been found to be both clinically effective and cost-effective in preventing the onset of diabetes mellitus type 2 (DMT2) in different settings. However, evidence is lacking for Mexico. The objective of this study was to analyze the lifetime cost-utility of lifestyle intervention and metformin compared with placebo, as well as lifestyle intervention compared with metformin in obese adults with prediabetes from the Mexican healthcare perspective. A Markov cohort simulation was used to track disease progression, direct medical costs and quality-adjusted life years (QALYs) to ultimately calculate the cost per QALY. Clinical evidence from the U.S. Diabetes Prevention Program on the progression from prediabetes to DMT2 was combined with data from the U.K. Prospective Diabetes Study on progression to common diabetes-related complications. Resource use was valued based on country-specific tariffs. Health utilities were derived from Mexican and U.S. studies. Uni- and bivariate sensitivity analyses were performed to test the robustness of the model. Uncertainty around the results was characterized in a probabilistic sensitivity analysis. All incremental cost-effectiveness ratios resulted negative. Lifestyle intervention and metformin were associated with an incremental net monetary benefit (INMB) of 1,451.57 US$ and 2,439.33 US$, respectively, compared with placebo at the threshold of once the national gross domestic product per capita per QALY. Lifestyle intervention compared with metformin was cost-saving with an INMB of 987,76 US$. The results were robust to structural changes and modifications in the lifestyle intervention group. The outcomes revealed constantly low levels of uncertainty. The results indicate that lifestyle intervention is a highly cost-effective alternative to treat prediabetes in obese adults in Mexico. However, its clinical effectiveness in Mexicans needs to be examined more thoroughly and a multi-sectoral approach to combat obesity and diabetes should be considered to overcome barriers to the successful implementation.