Health Affairs: Diabetes prevention programs could save $5.7B

With more than 26 million Americans suffering from diabetes and 79 million at risk for developing the comorbidity, working to thwart the disease and its associated costs should take center stage in preventive medicine. However, can disease prevention programs, which are often time-consuming and costly, make a dent in the epidemic? Research published in the January issue of Health Affairs showed that a community-based lifestyle intervention program could prevent nearly 885,000 cases of type 2 diabetes and save $5.7 billion over the next 25 years.

“The number of people in the U.S. with diabetes is projected to nearly double by 2034, to 44 million, with healthcare spending attributable to diabetes nearly tripling, to $336 billion,” Xiaohui Zhou, PhD, a health economist at the Centers for Disease Control and Prevention (CDC) in Atlanta, and colleagues wrote. “To prevent human suffering and reduce healthcare costs, policy makers have called for additional efforts to prevent type 2 diabetes.”

So far, the National Diabetes Prevention Program has attempted to impart evidence-based lifestyle intervention programs in the community to prevent the disease from occurring in those most at risk for type 2 diabetes. While most would give praise to these types of preventive programs, naysayers are worried about one thing—cost.

To estimate the costs of implementing these types of programs, Zhou et al simulated a prevention strategy that consisted of screening to identify a target population for an evidence-based lifestyle intervention to project the costs and outcomes of such a program.

The hypothetical intervention program screened adults ages 18 to 84 and those at a high risk for developing type 2 diabetes for the lifestyle intervention. The researchers used a type 2 diabetes simulation model developed by the CDC and RTI International to estimate the 25-year healthcare and economic outcomes of implementing a community-wide diabetes prevention program.

In the hypothetical intervention program, nearly 100 million Americans ages 18 to 84 would be screened over the next 25 years and nearly 23 million of those would have pre-diabetes. Another 13 million would be expected to be enrolled in a lifestyle intervention.

The researchers projected that nearly 885,000 new cases of type 2 diabetes would be prevented or delayed due to this program, which would result in a gain of 952,000 life-years and 669,000 quality-adjusted life-years over the next 25 years.

Additionally, the authors estimated that the program would cost $24.1 billion for screening, diagnosis and lifestyle intervention; however, that would result in $29.8 billion in downstream savings from treatment costs for those who may have developed type 2 diabetes.

Net savings of the intervention program would near $5.7 billion, according to the researchers. Additionally, the authors noted that the program would have the potential to extend a patient's expected life by three weeks and save an average of $330 per person over the next 25 years (people ages 64-84). For those between the ages of 18 and 64, the intervention had the potential to extend life expectancy by an average of one month and save $640 per patient.

For those age 65 to 84, the program could cost $1.2 billion ($300 million for screening costs and $900 million for lifestyle modification programs) the first year. “The net cost would continue to increase until year three, after which it would start to decline,” the researchers offered.

The projected cost savings would increase to $2.4 billion by year 25.

While these results were mostly positive, the researchers admit that several problems remain including:

• Budgeting for the long term: “Investing in chronic disease prevention programs requires adopting a longer term budgetary horizon because many years may be required for the downstream cost savings to fully offset the upfront intervention costs."

• Challenges in reaching the younger patient group (those ages 18-64): “There would be additional challenges in implementing the program for people in the younger group," the authors wrote.
• Resources required for implementation: “The initial implementation of the program would require a large amount of financial resources,” the authors wrote. Budgetary constraints could limit the number of people screened.
• Greater benefits in the younger group: A diabetes prevention program such as the one studied would achieve greater health and success if it were directed toward a younger population.

“The rising burden of type 2 diabetes in the United States has made its prevention a priority for public health agencies, healthcare professionals, private insurers and community organizations,” the authors concluded. Therefore, implementation of a community-wide prevention program for type 2 diabetes could improve health and reduce healthcare costs over time.