Health Promotion International, Vol 13, 197-210, Copyright © 1998 by Oxford University Press
L Segal, A Dalton and J Richardson
Non-insulin dependent diabetes mellitus (NIDDM) is a chronic disease, with
increasing prevalence widely reported. NIDDM is associated with high rates
of morbidity and premature mortality and is the cause of high health
service use. There is clinical, epidemiological and scientific evidence
that NIDDM is potentially preventable through weight loss, enhanced fitness
and nutrition modification. The research question addressed in this article
is whether the prevention of NIDDM is cost-effective compared with other
possible uses of our health care resources and whether some approaches to
NIDDM prevention are more cost-effective than others. Program types
analysed are surgery, group behavioural program, media campaign, general
practitioner (family physician) lifestyle advice, and intensive diet and
behavioural programs. Target groups include seriously obese persons, women
with previous gestational diabetes, over-weight men and all adults.
Expected diabetes years and life years were modelled for hypothetical
intervention and control cohorts and used, with information on program
cost, to derive estimates of cost-effectiveness, expressed as cost per
diabetes year avoided and cost per life year gained. Markov modelling was
used to track states of normal glucose tolerance, impaired glucose
tolerance (IGT) and NIDDM for intervention and control cohorts. Expected
life years were calculated through application of age and gender specific
mortality vectors, adjusted for diabetic state and weight loss. Expected
savings in health care costs from NIDDM prevention were based on estimated
annual cost of NIDDM management and were used to derive net
cost-effectiveness ratios. The group program for overweight men and media
programs were identified as extremely worthwhile, generating estimated net
savings in health care resources, while reducing diabetes incidence and
extending life expectancy. The behavioural/diet programs for high risk
groups were found to be highly cost-effective relative to other health care
programs, at an estimated net cost per life year saved of between
A
ARTICLES
Cost-effectiveness of the primary prevention of non-insulin dependent diabetes mellitus
Health Economics Unit, Monash University, C/-CHPE. Boronia Centre, Austin and Repat Hospital, PO Box 477, West Heidelberg, Victoria 3081, Australia; Corresponding author
1000 (US720) and A2600
(US1900). Surgery performed poorest, but still well at
A4600 (US3300) net cost per life year saved, if
targeted at persons with IGT. We conclude that the primary prevention of
NIDDM can be highly cost-effective. The development and funding of pilot
programs for NIDDM prevention is recommended to test these findings and
address the increasing incidence of NIDDM.Keywords:
cost-effectiveness; non-insulin dependant diabetes mellitus;
primary prevention
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