Health Economic Modelling of Prediabetes Progression and Type 2 Diabetes Risk Based on Published Data From a Swedish Intervention Program

OBJECTIVES: Quantify the long-term consequences of risk factors and interventions associated with the development and prevention of type 2 diabetes.

METHODS: Based on published data from a Swedish public intervention program (n=29,937), a health-economic (HE) Markov model was programmed. The model comprises the states normal glucose tolerance (NGT), impaired glucose tolerance (IGT), impaired fasting glucose (IFG), the combination of IGT & IFG, type 2 diabetes (T2D), and mortality. It was first validated against a pre-existing model and then enhanced in its capabilities to compute HE statistics. Furthermore, a comparative scenario including metformin therapy vs lifestyle modification was simulated over life-time from the perspective of the German healthcare system. Modifiable risk factors for prediabetes, such as physical inactivity, hypertension, smoking, and elevated triglyceride levels, were included. Key outcome measures included health-related quality of life and net monetary benefit (NMB), as well as survival, and state costs with comparisons made against a predefined willingness-to-pay threshold of €23,500 per quality adjusted life year (QALY) gained.

RESULTS: Individuals with a Body Mass Index (BMI) greater than or equal to 30 kg/m² had a 4.6% increased probability of developing T2D within the time horizon of 45 years, incurring additional costs of €4,350 per person. Elevated blood pressure (systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg) exerted the greatest impact on the development of combined IFG and IGT (+1.28% probability). male sex, BMI, blood pressure, family history, and smoking were identified as the most influential risk factors on the NMB. Both lifestyle modifications and metformin interventions demonstrated positive effects on preventing T2D. Yet, the chance of developing T2D decreased by 11.04% with lifestyle intervention and by 4.55% with metformin intervention.

CONCLUSIONS: This study confirms the crucial importance and quantifies the financial investment scope of preventive measures before the onset of diabetes from a German health system perspective.