Economic Evaluation of Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force

Abstract

Background: Diabetes is a highly prevalent and costly disease. Studies indicate that combined diet and physical activity promotion programs can prevent type 2 diabetes among persons at increased risk.

Purpose: To systematically evaluate the evidence on cost, cost-effectiveness, and cost-benefit estimates of diet and physical activity promotion programs.

Data sources: Cochrane Library, EMBASE, MEDLINE, PsycINFO, Sociological Abstracts, Web of Science, EconLit, and CINAHL through 7 April 2015.

Study selection: English-language studies from high-income countries that provided data on cost, cost-effectiveness, or cost-benefit ratios of diet and physical activity promotion programs with at least 2 sessions over at least 3 months delivered to persons at increased risk for type 2 diabetes.

Data extraction: Dual abstraction and assessment of relevant study details.

Data synthesis: Twenty-eight studies were included. Costs were expressed in 2013 U.S. dollars. The median program cost per participant was $653. Costs were lower for group-based programs (median, $417) and programs implemented in community or primary care settings (median, $424) than for the U.S. DPP (Diabetes Prevention Program) trial and the DPP Outcomes Study ($5881). Twenty-two studies assessed the incremental cost-effectiveness ratios (ICERs) of the programs. From a health system perspective, 16 studies reported a median ICER of $13 761 per quality-adjusted life-year (QALY) saved. Group-based programs were more cost-effective (median, $1819 per QALY) than those that used individual sessions (median, $15 846 per QALY). No cost-benefit studies were identified.

Limitation: Information on recruitment costs and cost-effectiveness of translational programs implemented in community and primary care settings was limited.

Conclusion: Diet and physical activity promotion programs to prevent type 2 diabetes are cost-effective among persons at increased risk. Costs are lower when programs are delivered to groups in community or primary care settings.

Primary funding source: None.

Figure 1

Summary of evidence search and selection. *Studies had abstracts only, were irrelevant, or did not meet inclusion criteria. †Did not meet inclusion criteria (for example, included persons with diabetes or had physical activity or diet component but not both). Two studies were conducted in low- or middle-income countries, and 1 did not follow a rigorous cost–benefit analysis.

Figure 2

Scatterplot of ICERs from 16 cost-effectiveness or cost–utility analyses that reported cost per QALY saved from the health system perspective. DPP = Diabetes Prevention Program; ICER = incremental cost-effectiveness ratio; IQI = interquartile interval; QALY = quality-adjusted life-year. *$13 761 per QALY saved (IQI, $3067 to $21 899).