1932-LB: Cost-Effectiveness of the National Diabetes Prevention Program—A Real-World, Two-Year Prospective Study

Few studies have examined the cost-effectiveness of the National Diabetes Prevention Program (NDPP) in real-world settings. We evaluated the real-world cost-effectiveness of the NDPP in people with prediabetes in a large workforce with employer-sponsored health insurance. We performed individual-level, empirical data analyses using surveys and health insurance claims for 6,179 adult employees, dependents, and retirees with prediabetes who enrolled (n=592) or did not enroll (n=5,587) in the NDPP. We assessed direct medical costs the year before NDPP enrollment/index date (baseline) through 2 years afterward, EQ-5D-5L utility scores at baseline and 2 years afterward, and quality-adjusted life-years (QALYs) over 2 years for NDPP enrollees and non-enrollees. We applied propensity score weighting to adjust for bias due to self-selection for enrollment, multiple imputations to handle missing data, and bootstrap method to produce confidence intervals (CIs). We adopted a health system perspective and discounted costs and QALYs at 3% annually. Costs were expressed in 2020 U.S. dollars. Compared to non-enrollees, the average reduction in direct medical costs per enrollee was $3,979 (95% CI: -$11,962 to $2,019) over 2 years. The cost savings were primarily related to fewer hospitalizations (-$3,016), outpatient visits (-$639), and emergency room visits (-$272) among enrollees. Each enrollee accrued 1.726 QALYs and each non-enrollee accrued 1.702 QALYs over 2 years, representing a gain of 0.024 (95% CI: -0.007 to 0.052) QALY per enrollee. The uncertainty analyses showed a high probability (75%) of cost savings, and an 89% probability of being cost-effective at a willingness-to-pay threshold of $100,000 per QALY gained, for NDPP enrollees versus non-enrollees. In this real-world population with prediabetes, enrollment in the NDPP was likely to provide cost savings and improve quality-adjusted life-expectancy. Further research is warranted to confirm these findings.