Cost-Effectiveness of Structured Lifestyle Programs for Diabetes Prevention in the Medicaid Population

Background: The Diabetes Prevention Program (DPP) showed that structured lifestyle interventions can delay or prevent onset of type 2 diabetes in high risk individuals. Despite disproportionate diabetes burdens in low-income individuals, there are no data regarding expected health and economic impacts of structured diabetes prevention in the Medicaid population.

Objective: To examine the net costs and health benefits of extending coverage for structured lifestyle programs to the Medicaid population.

Methods: We modelled a prevention strategy consisting of triannual screening for prediabetes (FPG?100 mg/dl or A1c?5.7%) followed by a DPP-like lifestyle program vs. routine care in non-disabled U.S. Medicaid beneficiaries aged 25-64 years. Medicaid population characteristics were extracted from 2006-2016 NHANES surveys. Costs of diabetes and its complications were estimated from Medicaid administrative claims data of 8 states comprising 52% of the U.S. adult Medicaid population. Based on DPP-like studies in Medicaid populations, we assumed the intervention will reduce diabetes incidence by 32% and will be delivered at costs defined in the Medicare Payment Scheme. We estimated incremental health benefits (in quality-adjusted life-years (QALYs)) gained and net costs (in 2016 U.S. dollars) of screening and delivering lifestyle programs and subtracted savings through prevention of diabetes from a Medicaid perspective over a 10 year time horizon.

Results: Given a 25% screening and intervention uptake in approximately 27 million non-disabled Medicaid beneficiaries across 50 states, extending coverage could prevent or delay 135,000 cases of diabetes, gain 243,000 QALYs, and cost $1.35 billion (incremental cost effectiveness ratio $55,000 per QALY gained).

Conclusions: Extending Medicaid coverage for life-style diabetes prevention programs might be a good use of health care resources and will potentially diminish the diabetes burden in low income individuals.