Cost-Effectiveness of Interventions to Prevent and Manage Diabetes—A Systematic Review and Update

Many interventions are available for preventing type 2 diabetes (DM) and managing DM, but their cost-effectiveness (CE) varies greatly. Previously, we conducted a systematic cost-effectiveness (CE) review of all DM interventions covering studies between 1985 and 2007. Here, we update the study for Jan 20to July 2017. We used the same search strategies (databases, MeSH terms and keywords, exclusion criteria and study quality assessment tool) to select studies. We grouped interventions by CE ratios (CER) in cost per quality-adjusted life years (QALY) or life year gained (LYG)—cost saving (CER ≤ 0); very cost-effective (0 < CER ≤ $25,000); cost-effective ($25,000 < CER ≤ $50,000); marginally cost-effective ($50,000 < ICER ≤ $100,000); or not cost-effective (>$100,000)—and whether evidence was strong, supportive, or uncertain. We used the median CER to represent the CE of an intervention if multiple evaluations exist. Costs and CER were expressed as 2015 U.S. dollars. The initial search yielded 18,195 titles; 46 prevention and 110 management papers were included in the review. Interventions that were cost-saving or very cost-effective with strong evidence included: for preventing type 2 DM, 1) imposing taxes on sweetened beverages and 2) structured lifestyle intervention and metformin in people at high risk; for management of DM and its complications, 1) ACE inhibitor therapy for intensive hypertension (HTN) control, 2) self-monitoring of blood glucose, 3) comprehensive foot care to prevent ulcers, 4) multi-component coordinated care with peer support for managing HTN, hyperglycemia, hyperlipidemia, and chronic kidney disease, and early detection of DM complications. The CERs of other interventions ranged from $30,000 to $4,817,000 per QALY or <$25,000 per QALY with a high degree of uncertainty. Our results provide critical information for making evidence-based clinical and public health policy decisions.