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A cost-effectiveness analysis of a community-based diabetes prevention program in Sweden

  • Pia Johansson (a1), Claes-Göran Östenson (a1), Agneta M. Hilding (a1), Camilla Andersson (a1), Clas Rehnberg (a1) and Per Tillgren (a1)...

Objectives: Lifestyle changes to prevent type 2 diabetes among high-risk persons have been shown to be cost-effective. This study investigates the cost-effectiveness of a community-based program promoting general population lifestyle changes to prevent diabetes.

Methods: The 10-year program was implemented in three municipalities in Sweden. Effectiveness was measured with a quasiexperimental cohort design, that is, risk factor levels in a population group aged 36–56 years at baseline and 8–10 years later (2,149 men; 3,092 women) in the program municipalities and a control area were compared. The incremental cost-utility analysis included future diabetes and cardiovascular disease-related health effects and societal costs (discounted 3 percent), estimated by a Markov model.

Results: In all areas, risk factor levels increased during follow-up, leading to increased societal costs of between SEK40,000 and 90,000 (1 Euro 2004 = SEK9.13; 1 US$ = SEK 7.35) and quality-adjusted life-year (QALY) losses between 0.12 and 0.48 per individual. Compared with the control area, the cost increases and QALY losses for women were more favorable in two program areas but less favorable in one, and less favorable for men in both areas (data unavailable for one municipality). The findings indicate that the program was cost-effective in only two female study groups.

Conclusions: Conflicting results on the cost-effectiveness of the program were obtained. As several potentially valuable aspects of the program are not included in the cost-effectiveness analysis, the societal value of the program might not be adequately reflected.

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1. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome–a new world-wide definition. A consensus statement from the International Diabetes Federation. Diabet Med. 2006;23:469480.
2. Andersson CM, Bjärås GE, Östenson CG. A stage model for assessing a community-based diabetes prevention program in Sweden. Health Promot Int. 2002;17:317327.
3. Andersson CM, Bjärås G, Tillgren P, Östenson CG. A longitudinal assessment of inter-sectoral participation in a community-based diabetes prevention programme. Soc Sci Med. 2005;61:24072422.
4. Andersson C. Challenges of studying complex community health promotion programmes [thesis]. Stockholm: Karolinska Institutet; 2006.
5. Bauman A, Koepsell TD. Epidemiologic issues in community intervention. In: Brownson RC, Pettiti DB, eds. Applied epidemiology – theory to practice. 2nd ed. Oxford: Oxford University Press; 2006:164206.
6. Bjärås G, Ahlbom A, Alvarsson M, et al. Strategies and methods for implementing a community-based diabetes primary prevention program in Sweden. Health Promot Int. 1997;12:151160.
7. Borghi J, Jan S. Measuring the benefits of health promotion programmes: Application of the contingent valuation method. Health Policy. 2008;87:235248.
8. Bracht N, Kingsbury L. Community organization principles in health promotion. A five-stage model. In: Bracht N, ed. Health promotion at the community level. Newbury Park: SAGE; 1990:6688.
9. Briggs AH. Handling uncertainty in economic evaluation and presenting the results. In: Drummond M, McGuire A, eds. Economic evaluation in health care. Merging theory with practice. Oxford: Oxford University Press; 2001:172214.
10. Caro JJ, O'Brien JA, Hollenbeak CS, et al. Economic burden and risk of cardiovascular disease and diabetes in patients with different cardiometabolic risk profiles. Value Health. 2007;10:S12-S20.
11. Drummond M, Weatherly H, Claxton K, et al. Assessing the challenges of applying standard methods of economic evaluation to public health interventions. York: Public Health Research Consortium; 2008.
12. Eriksson AK, Ekbom A, Granath F, et al. Psychological distress and risk of pre-diabetes and Type 2 diabetes in a prospective study of Swedish middle-aged men and women. Diabet Med. 2008;25:834842.
13. Eriksson L, Johansson P. Kostnadsberäkning av det befolkningsinriktade arbetet inom SDPP, Stockholms läns diabetespreventiva program [Cost calculation of the community-based work within SDPP]. Stockholm: Stockholms läns diabetespreventiva program, Stockholm County Council; 2005. Report 31.
14. Feldman I, Lund C, Johansson P. A model for economic evaluations of metabolic syndrome interventions – technical report. Stockholm, Uppsala: Karolinska Institutet School of Public Health, Uppsala county council; 2009. and
15. Gillies CL, Abrams KR, Lambert PC, et al. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: Systematic review and meta-analysis. BMJ. 2007;334:299.
16. Gold MR, Siegel JE, Russell LB, Weinstein MC, eds. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.
17. Gundgaard J, Nielsen JN, Olsen J, Sörensen J. Increased intake of fruit and vegetables: Estimation of impact in terms of life expectancy and healthcare costs. Public Health Nutr. 2003;6:2530.
18. Herman WH, Hoerger TJ, Brandle M, et al. for the Diabetes Prevention Program Research Group. The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern Med. 2005;142:323332.
19. Hoerger TJ, Hicks KA, Sorensen SW, et al. Cost-effectiveness of screening for pre-diabetes among overweight and obese U.S. adults. Diabetes Care. 2007;30:28742879.
20. Johansson P. Economic evaluation of public health programmes – Constraints and opportunities [thesis]. Stockholm: Karolinska Institutet; 2009.
21. LFN (Swedish Pharmaceutical Benefits Board). General guidelines for economic evaluations from the Pharmaceutical Benefits Board (LFNAR 2003:2). (accessed May 30, 2008).
22. Lindgren P, Lindström J, Tuomilehto J, et al. for the DPS Study Group. Lifestyle intervention to prevent diabetes in men and women with impaired glucose tolerance is cost-effective. Int J Technol Assess Health Care. 2007;23:177183.
23. Neumann PJ, Rosen AB, Greenberg D, et al. Can we better prioritize resources for cost-utility research? Med Decis Making. 2005;25:429436.
24. Nutbeam D. Evaluating health promotion – progress, problems and solutions. Health Promot Int. 1998;13:2744.
25. Sörensen J, Horsted C, Andersen LB. Modellering af potentielle sundhedsökonomiske konsekvenser ved öget fysisk aktivitet i den voksne befolkning [Modeling the potential health care economic consequences from increased physical activity in the adult population]. Odense: CAST, Syddansk Universitet;2005.
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International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
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