COST-EFFECTIVENESS OF A STRUCTURED LIFESTYLE INTERVENTION FOR TYPE 2 DIABETES PREVENTION IN PRIMARY CARE IN SPAIN
Author(s)
Lucía Pedrosa Pérez, PhD1, Esther-Elena Garcia-Carpintero, PhD1, Montserrat Carmona, PhD1, Carlos Sanchez-Piedra, PhD1, Javier Martín-Román, PhD2.
1Instituto de Salud Carlos III - Health Technology Assessment Agency (AETS), Madrid, Spain, 2National Distance Education University (UNED), Department of Applied Economics and Public Management, Madrid, Spain.
1Instituto de Salud Carlos III - Health Technology Assessment Agency (AETS), Madrid, Spain, 2National Distance Education University (UNED), Department of Applied Economics and Public Management, Madrid, Spain.
OBJECTIVES: Type 2 diabetes (T2DM) represents a major public health and economic burden in Spain. Although lifestyle interventions have shown effectiveness in clinical trials, evidence on their cost-effectiveness and on comparisons across different delivery formats in real-world primary care (PC) remains limited. This study assessed the cost-effectiveness of a structured intensive lifestyle intervention (SILI), including group-based (G-SILI) and individual-based (I-SILI) formats, compared with usual opportunistic advice in individuals at moderate/high risk of T2DM or with prediabetes.
METHODS: A Markov model with annual cycles was developed to simulate disease progression across five health states: high risk, prediabetes, T2DM, non-adherence, and death. The intervention consisted of a structured 6-hour lifestyle program delivered by nurses, including educational sessions on diet, physical activity, and behavioural change, in group or individual formats. The analysis adopted the Spanish National Health System (SNHS) perspective, including direct medical costs and quality-adjusted life years (QALYs). Transition probabilities for the first 4 years were derived from the DE-PLAN-CAT study, extrapolated to a 20-year horizon with gradual effectiveness decay. Costs and utilities were obtained from official sources and literature, and both were discounted at 3.5%. Deterministic and probabilistic sensitivity analyses were performed.
RESULTS: At 4 years, SILI showed an ICER of €5,966/QALY compared with usual care, while G-SILI was more cost-effective (€4,192/QALY) and generated greater QALY gains. In contrast, I-SILI was dominated, yielding higher costs and lower effectiveness. At 20 years, results remained consistent: SILI (€7,363/QALY) and G-SILI (€5,104/QALY) were cost-effective under commonly cited Spanish thresholds (€27,000-€34,000/QALY), with G-SILI maintaining the most favourable efficiency profile. I-SILI remained dominated.
CONCLUSIONS: Intensive lifestyle interventions in PC for T2DM prevention are likely to be cost-effective in the SNHS, particularly when delivered in group formats. Individual-based delivery may be less efficient. These findings suggest that group-based strategies may be a promising approach in PC.
METHODS: A Markov model with annual cycles was developed to simulate disease progression across five health states: high risk, prediabetes, T2DM, non-adherence, and death. The intervention consisted of a structured 6-hour lifestyle program delivered by nurses, including educational sessions on diet, physical activity, and behavioural change, in group or individual formats. The analysis adopted the Spanish National Health System (SNHS) perspective, including direct medical costs and quality-adjusted life years (QALYs). Transition probabilities for the first 4 years were derived from the DE-PLAN-CAT study, extrapolated to a 20-year horizon with gradual effectiveness decay. Costs and utilities were obtained from official sources and literature, and both were discounted at 3.5%. Deterministic and probabilistic sensitivity analyses were performed.
RESULTS: At 4 years, SILI showed an ICER of €5,966/QALY compared with usual care, while G-SILI was more cost-effective (€4,192/QALY) and generated greater QALY gains. In contrast, I-SILI was dominated, yielding higher costs and lower effectiveness. At 20 years, results remained consistent: SILI (€7,363/QALY) and G-SILI (€5,104/QALY) were cost-effective under commonly cited Spanish thresholds (€27,000-€34,000/QALY), with G-SILI maintaining the most favourable efficiency profile. I-SILI remained dominated.
CONCLUSIONS: Intensive lifestyle interventions in PC for T2DM prevention are likely to be cost-effective in the SNHS, particularly when delivered in group formats. Individual-based delivery may be less efficient. These findings suggest that group-based strategies may be a promising approach in PC.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE20
Topic
Economic Evaluation, Health Technology Assessment
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)