the cost-effectiveness (CE) of an intensive lifestyle
intervention (ILI) compared to standard diabetes support and education (DSE) in
adults with overweight/obesity and type 2 diabetes, as implemented in the Action
for Health in Diabetes study.
RESEARCH DESIGN AND METHODS Data were from 4,827
participants during the first 9 years of the study from 2001 to 2012. Information
on Health Utility Index-2 and -3, SF-6D, and Feeling Thermometer [FT]), cost of
delivering the interventions, and health expenditures were collected during the
study. CE was measured by incremental cost-effectiveness ratios (ICERs) in costs
per quality-adjusted life year (QALY). Future costs and QALYs were discounted
at 3% annually. Costs were in 2012 US dollars.
RESULTS Over the 9
years studied, the mean cumulative intervention costs and mean cumulative
health care expenditures were $11,275 and $64,453 per person for ILI and $887 and
$68,174 for DSE. Thus, ILI cost $6,666 more per person than DSE. Additional QALYs
gained by ILI were not statistically significant measured by the HUIs and were
0.17 and 0.16, respectively, measured by SF-6D and FT.
The ICERs ranged from no health benefit with a higher cost based on HUIs, to $96,458/QALY
and $43,169/QALY, respectively, based on SF-6D and FT.
Conclusions Whether ILI was cost-effective over the 9-year period is unclear because different
health utility measures led to different conclusions.
This study is supported by the Department of Health and Human Services through the following cooperative agreements from the National Institutes of Health: DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, and DK56992. The following federal agencies have contributed support: National Institute of Diabetes and Digestive and Kidney Diseases; National Heart, Lung, and Blood Institute; National Institute of Nursing Research; National Center on Minority Health and Health Disparities; NIH Office of Research on Women’s Health; and the Centers for Disease Control and Prevention. This research was supported in part by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases. The Indian Health Service (I.H.S.) provided personnel, medical oversight, and use of facilities. The opinions expressed in this paper are those of the authors and do not necessarily reflect the views of the I.H.S. or other funding sources. Additional support was received from The Johns Hopkins Medical Institutions Bayview General Clinical Research Center (M01RR02719); the Massachusetts General Hospital Mallinckrodt General Clinical Research Center and the Massachusetts Institute of Technology General Clinical Research Center (M01RR01066); the University of Colorado Health Sciences Center General Clinical Research Center (M01RR00051) and Clinical Nutrition Research Unit (P30 DK48520); the University of Tennessee at Memphis General Clinical Research Center (M01RR0021140); the University of Pittsburgh General Clinical Research Center (GCRC) (M01RR000056), the Clinical Translational Research Center (CTRC) funded by the Clinical & Translational Science Award (UL1 RR 024153) and NIH grant (DK 046204); the VA Puget Sound Health Care System Medical Research Service, Department of Veterans Affairs; and the Frederic C. Bartter General Clinical Research Center (M01RR01346). The fol