Economic Evaluation of the GOAL Lifestyle Intervention to Prevent Type-2 Diabetes

Abstract

Several RCT studies have shown that prevention of type 2 diabetes is feasible via lifestyle interventions. Nevertheless, the empirical evidence for economic effectiveness of prevention in real-world settings is scarce. We analyze costs and effectiveness of a specific type 2 diabetes prevention program in Finland, the GOAL Lifestyle Implementation Trial (GOAL LIT). We developed a Markov model with five mutually exclusive (disease) states and discrete one-year intervals to simulate the health effects of the intervention over 15 years. Based on the 3-year follow-up results from the intervention and a risk factor matched control group, we computed annual transition probabilities between BMI levels. The mortality differences between intervention and control group after 15 years are insignificant for both sexes. Projected cumulative costs of diabetes for both sexes are significantly lower in the intervention group compared to control group. From the perspective of the health care system the cost saving of the study depends on the assumed degree of complications with type 2 diabetes. For an all-male intervention group, the net benefit is positive above the threshold of 8 per cent average annual complication rate. The average overall monetary gain of the intervention then lies between €213.8 and €354.8 per person. The GOAL LIT would also be cost-effective, if the program was conducted in a representative Finnish population, with possible costs savings following the intervention between €64.8 and €155.8 per person. The results indicate that a diabetes prevention program like the GOAL LIT can be cost effective. Potential cost effects are mainly due to male participants, but nevertheless also notable in a representative population. However, our framework only focuses on one obesity related disease and thus tends to underestimate the cost savings as well as potential mortality benefits.