Abstract
Aims Type 2 diabetes mellitus (T2DM) is a health challenge in China, and the economic outcomes of lifestyle intervention are critically important for policymakers. This study estimates the lifetime economic outcomes of lifestyle intervention among the prediabetic population in the Chinese context. Methods We developed a mathematical model to compare the cost-effectiveness of lifestyle intervention and no prevention in the prediabetic population. Efficacy and safety, medical expenditure, and utility data were derived from the literature, which was assigned to model variables for estimating the quality-adjusted life-years (QALYs) and costs as well as incremental cost-effectiveness ratios (ICERs). The analysis was conducted from the perspective of Chinese healthcare service providers. One-way and probabilistic sensitivity analyses were performed. Results Compared with no prevention, lifestyle intervention averted 9.53% of T2DM, which translated into an additional 0.52 QALYs at a saved cost of $700 by substantially reducing the probabilities of macro- and microvascular diseases. This finding indicated that lifestyle intervention was a dominant strategy. The sensitivity analyses showed the model outputs were robust. Conclusions Lifestyle intervention is a very cost-effective alternative for prediabetic subjects and worth implementing in the Chinese healthcare system to reduce the disease burden related to T2DM.
Highlights
With the largest population, the prevalence of diabetes in China is 11.6% of adults [1, 2]
The model was more sensitive to the cost of the lifestyle intervention and the hazard ratio of developing diabetes between lifestyle intervention and no intervention because they were found to have a substantial impact on incremental cost-effectiveness ratios (ICERs)
It is the first economic evaluation that estimated, in Chinese subjects with prediabetes, the initiation of lifestyle intervention was associated with improvements in length and quality of life and saving money by preventing or delaying Type 2 diabetes mellitus (T2DM)
Summary
The prevalence of diabetes in China is 11.6% of adults [1, 2]. It has been shown that allage disability-adjusted life-years (DALYs) of diabetes were increased by 24.4% (95% CI: 22.7–26.2) from 1990 to 2016 according to the Global Burden of Disease Study [3]. Lifestyle intervention has been advocated to decrease the risk of T2DM in prediabetic subjects, which could reduce 3% absolute risk compared with no prevention [6,7,8]. Chinese diabetes society encouraged lifestyle intervention to decrease the risk of diabetes in general and high-risk population [10]. Because the economic results from other countries may not be generalizable to the Chinese context, we sought to determine the anticipated health economic outcomes for lifestyle intervention in high-risk population and compare it to those with no prevention in the Chinese healthcare setting
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