Cost-effectiveness of the National Diabetes Prevention Program: A real-world, 2-year prospective study

Objective:

We evaluated the real-world cost-effectiveness of the National Diabetes Prevention Program (NDPP) in people with prediabetes in a large workforce with employer-sponsored health insurance.

Research Design and Methods:

We performed difference-in-differences analyses using individual-level health insurance claims and survey data for 5,948 adults with prediabetes who enrolled (n=575) or did not enroll (n=5,373) in the NDPP to assess NDPP’s effects on health economic outcomes. We assessed direct medical costs for the year before NDPP enrollment/index date and for 2 years thereafter, EQ-5D-5L utility scores at baseline, 1-year, and 2-years, and quality-adjusted life-years (QALYs) over 2 years. We used propensity score weighting to adjust for potential bias due to self-selection for enrollment, multiple imputation to handle missing data, and bootstrapping to produce confidence intervals (CIs). We adopted a healthcare sector perspective and discounted costs and QALYs at 3% annually. Costs were expressed in 2020 U.S. dollars.

Results:

Compared to non-enrollees, each NDPP enrollee had an average reduction of $4,552 (95% CI: -$13,231 to $2,014) in 2-year total direct medical costs. Cost savings were primarily related to hospitalizations, outpatient visits, and emergency room visits. Compared to non-enrollees, each enrollee had no difference in EQ-5D-5L utility scores at 2-years or QALYs-gained over 2 years. The uncertainty analyses found that enrollment in the NDPP had an 88% probability of saving money and 84% probability of being cost-effective at a willingness-to-pay threshold of $100,000/QALY-gained over 2 years.

Conclusions:

In this real-world population with prediabetes, enrollment in the NDPP was likely to provide cost savings.