Suggested citation for this article: Smith KJ, Hsu HE, Roberts MS, Kramer MK, Orchard TJ, Piatt GA, et al.
We assessed the cost-effectiveness of a community-based, modified Diabetes Prevention Program (DPP) designed to reduce risk factors for type 2 diabetes and cardiovascular disease.
We consider the modified DPP delivered in community and primary care settings a sound investment. Community-based lifestyle interventions adapted from the DPP (1) demonstrate effectiveness for improving the risk factors for diabetes in community settings (8-10), but their costs are largely unexplored. The second study was a nonrandomized prospective trial to test intervention effectiveness in an urban, medically underserved community (8).
Participants who begin the program but do not return for the 12-month follow-up are considered nonenrolled, thus accounting for withdrawal from the program. We performed 1-way sensitivity analyses and probabilistic sensitivity analyses on model input parameters.
During the 3-year time frame of the model, both costs and effectiveness of the mDPP were slightly higher than usual care.
When base case values were used for all parameters, an mDPP intervention cost $3,420 per QALY. In a separate sensitivity analysis examining differing assumptions for metabolic syndrome reduction, if we assume no reduction in metabolic syndrome for enrolled or nonenrolled patients after model year 1, the cost-effectiveness ratio of the intervention increased slightly, to $3,400 per QALY gained.
The mDPP was designed to teach groups of people how to change their diet and lifestyle to reduce their risk for diabetes and CVD.
In analyzing the mDPP, we used several conservative practices and assumptions that would be expected to negatively bias our findings. Both the original DPP and the mDPP provide study participants with instructions about diet and physical activity. Portions of this research were sponsored by funding from the US Air Force, administered by the US Army Medical Research Acquisition Activity, Fort Detrick, Maryland, Award Number W81XWH-04-2-003. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study.
Translating the Diabetes Prevention Program into an urban medically underserved community: a nonrandomized prospective intervention study.
Clinical outcomes and cost-effectiveness of strategies for managing people at high risk for diabetes.

The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Group lifestyle intervention for diabetes prevention in those with metabolic syndrome in primary care practice. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Trends in the incidence of type 2 diabetes mellitus from the 1970s to the 1990s: the Framingham Heart Study. UKPDS 60: risk of stroke in type 2 diabetes estimated by the UK Prospective Diabetes Study risk engine. Risk factors for cardiovascular mortality and morbidity: the WHO Multinational Study of Vascular Disease in Diabetes. Toward consistency in cost-utility analyses: using national measures to create condition-specific values. What does the value of modern medicine say about the $50,000 per quality-adjusted life-year decision rule? Sir,Laron syndome is named after Zvi Laron, the Israeli researcher who first reported this condition in 1966. 4.Galli-Tsinopoulou A, Nousia-Arvanitakis S, Tsinopoulos I, Bechlivanides C, Shevah O, Laron Z. Cost-effectiveness analysis of efforts to reduce risk of type 2 diabetes and cardiovascular disease in southwestern Pennsylvania, 2005-2007. The Diabetes Prevention Program (DPP) found that either medication or intensive lifestyle interventions could prevent progression from impaired glucose tolerance to diabetes (1). However, intervention efficacy and cost data for these studies were largely based on the intensive strategies and resources used by the original DPP (14,15). They screened and recruited participants through the practices and hired trained preventionists who were health care professionals to deliver the program.
Program costs, recruitment and retention rates, patient demographics, and program effectiveness were derived from the 2 community-based studies.
They are considered to be risk-factor–negative if they do not meet either of these sets of criteria.
Those enrolling in the program show metabolic syndrome resolution at rates found in the mDPP interventions during the first year of the model. In these analyses, the parameters (Table) were varied either individually or collectively over their listed ranges, with 1,000 recalculations of incremental cost-effectiveness ratios based on random draws from the parameter distributions.
Horizontal bars depict the range of cost-effectiveness ratios for the values shown for each parameter. When parameters were varied to the extremes of the ranges shown in the Table, the cost-effectiveness ratio remained less than $20,000 per QALY. This analysis assumed independence among parameter values and did not account for covariance between parameters, which tends to broaden result ranges.

The acceptability curve depicts the likelihood of an mDPP lifestyle intervention being favored for a given cost-effectiveness ceiling threshold (willingness to pay). Given the short time frame of our analysis, the factors that contributed the most to intervention effectiveness were the changes in quality of life that are due to avoidance of diabetes and its complications.
The main difference is that the DPP provides individualized instruction to participants with specific types of comorbidities, whereas the mDPP provides group instruction and can be applied to participants with a larger range of comorbidities. Bryce, PhD, Associate Professor of Medicine, University of Pittsburgh School of Medicine, 200 Meyran Ave, Suite 200, Pittsburgh, PA 15213. It is a rare genetic disease where the body has sufficient growth hormones but lacks receptors to utilize the hormone and, hence, dwarfism results. Laron syndrome (primary growth hormone resistance or insensitivity): The personal experience 1958-2003. In probabilistic sensitivity analysis, the intervention cost less than $20,000 per quality-adjusted life-year gained in approximately 78% of model iterations. This randomized controlled trial provided study participants with individualized, resource-intensive management and oversight (5). Subjects may remain in a health state (short curved arrow) or may move to a different health state (straight arrow or long curved arrow) during each model cycle. Incidence and prevalence parameters were varied over beta distributions, relative risks were varied over log-normal distributions, and cost multipliers were varied over normal distributions.
When delivered in community and primary care settings, it is cost-effective and appears to be a sound investment.
Variation of all other parameters not shown in the figure did not increase the cost-effectiveness ratio above $7,000 per quality-adjusted life-year (QALY) gained. There was no history suggestive of birth asphyxia, neonatal seizures, or neonatal jaundice.
Child grew well in height and weight till a year of age, but subsequent growth was retarded. Father and mother are of Aryan sub-race of Caucasian ethnicity, with heights of 168 cm and 152 cm, respectively. Frontal prominence was present, hairs were silky and sparse, nasal bridge was depressed, and ears were low set.
Both children had clinical features of growth hormone deficiency, but when investigated, they showed a high level of growth hormone and low serum level of IGF-1. Treatment consists of administration of recombinant human IGF-1, frequent meals to avoid hypoglycemia (especially during infancy), regular monitoring of growth and development, and regular monitoring of blood sugar levels and adverse effects of IGF-1 therapy.

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