Clinical and cost‐effectiveness of primary prevention of Type 2 diabetes in a ‘real world’ routine healthcare setting: model based on the KORA Survey 2000

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Abstract
Aims  To analyse the clinical and cost‐effectiveness of the primary prevention of Type 2 diabetes in a ‘real world’ routine healthcare setting using population‐based data (KORA Survey in Augsburg, Germany, total population approximately 600 000).Methods  Decision analytic model, time horizon 3 years.Interventions  Staff education, targeted screening and lifestyle modification or metformin in people aged 60–74 years with a body mass index of ≥ 24 kg/m2 and prediabetic status (fasting glucose 5.3–6.9 mmol/l and 2‐h post load glucose 7.8–11.0 mmol/l) (target population approximately 72 500), according to the Diabetes Prevention Program trial.Main outcome measures  Cases of Type 2 diabetes prevented, cost (Euro), incremental cost‐effectiveness ratios (ICERs).Results  Under model assumptions, 14 908 people in the target population would develop diabetes if there was no intervention, 184 cases would be avoided with lifestyle intervention and 42 cases with metformin intervention. From the perspective of statutory health insurance and society, costs for lifestyle modification were a856 507 (£574 241) and a4 961 340 (£3 326 307), respectively, and for metformin a797 539 (£534 706) and a1 335 204 (£895 181). Up to 5% of the costs were due to staff education and up to 36% to screening. Lifestyle was more cost effective than metformin. ICERs for lifestyle vs. ‘no intervention’ were a4664 (£3127) and a27 015 (£18 112) per case prevented from the statutory health insurance and societal perspective.Conclusions  Total cost and cost per case of diabetes avoided was high. Staff education and screening had a considerable impact. In view of the low participation in a routine healthcare setting, with both strategies only a small number of cases of diabetes would be prevented. Before implementing the programme, efforts should be made to improve patient participation in order to achieve better clinical and cost‐effectiveness of the prevention of Type 2 diabetes in ‘real world’ clinical practice.

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