The medical costs of treating type 2 diabetes (T2D) can be considered a counterfactual to measure the value for preventing T2D. This study examined changes in the cost-effectiveness of the structured lifestyle intervention (SLI) to prevent T2D, attributable to the sharp increase in the costs of T2D between 20 and 2018. We developed a patient-level discrete-time microsimulation model for diabetes progression and mortality in people eligible for SLI as specified in the National Diabetes Prevention Program (NDPP) using data from the 2009-20 National Health and Nutrition Examination Survey (NHANES) with linked National Death Index, and published literature. We used the Medical Expenditure Panel Survey to develop a health utility equation (2018 data) and two cost equations (20 and 2018 data) . We simulated the long-term health and economic consequences of SLI using the simulation model based on 20 and 2018 cost equations, respectively. We took a payers’ perspective, and all costs were standardized to 2018 USD. The incremental net benefit (INB) was estimated using a $50,000/QALY. The SLI achieved cost-saving over a 20-year time horizon in a scenario using 2010’s costs but only 9 years under 2018’s costs. Based on 20 costs, SLI costs below $997 and $2,153 would make the SLI cost-saving and cost-effective, respectively, over a 20-year window. Based on 2018 costs, if SLI costs were below $1,479 and $2,635, respectively, it would be cost-saving and cost-effective over 20 years. Subgroup analysis suggested the SLI was more cost-effective in the Hispanic adults (INB:$5,383) than non-Hispanic white (INB: $2,192) and black (INB:$2,364) adults. From 20 to 2018, the increasing medical costs for treating T2D has led to a higher likelihood and shorter time horizon for SLI to be cost-saving. This suggests that payers can raise reimbursements for SLI programs to make the adoption of these programs more feasible for delivery systems while maintaining economic value.


W.Huang: None. D.Guan: None. S.Niu: None. M.K.Ali: Advisory Panel; Bayer AG, Research Support; Merck & Co., Inc. Y.Zhang: None. J.Guo: None. H.Shao: Board Member; BRAVO4HEALTH, LLC.

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