Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes.

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metabolic syndrome 2 endocrinologydiseases
metformin 41 endocrinologydiseasesdrugs
obesity 2 endocrinologydiseases

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metformin 122 OpenPreventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin , with and without screening, for pre-diabetesSamantha RobertsEleanor BarryDawn CraigMara AiroldiGwyn
metformin 445 date (epub): 11/2017AbstractObjectiveExplore the cost-effectiveness of lifestyle interventions and metformin in reducing subsequent incidence of type 2 diabetes, both alone and in combination with a screening
metformin 825 PreMedline, NHS EED) and citation tracking identified economic evaluations of lifestyle interventions or metformin alone or in combination with screening programmes in people at high risk of developing diabetes. The
metformin 1249 quality.Results27 studies were included; all had evaluated lifestyle interventions and 12 also evaluated metformin . Primary studies exhibited considerable heterogeneity in definitions of pre-diabetes and intensity and
metformin 1421 definitions of pre-diabetes and intensity and duration of lifestyle programmes. Lifestyle programmes and metformin appeared to be cost effective in preventing diabetes in high-risk individuals (median incremental cost-effectiveness
metformin 2297 insufficient evidence to answer the question of (1) whether lifestyle programmes are more cost effective than metformin or (2) whether low-intensity lifestyle interventions are more cost effective than the more intensive
metformin 3006 economic evaluations of diabetes prevention programmes and the only one to include comparison with metformin and consideration of relevance and credibility for policymakers. We undertook a detailed analysis of
metformin 6088 US trial, the US Diabetes Prevention Program (USDPP), lifestyle programmes were less effective and metformin more effective in participants with IGT, IFG and HbA1c in the ‘at-risk range’ compared with the
metformin 8243 may be offered a lifestyle programme (to encourage a healthy diet and increased physical activity) or metformin . These interventions have been shown to delay or prevent type 2 diabetes in a significant proportion
metformin 10174 diabetes prevention programme; (3) the role of different types of interventions (lifestyle programmes or metformin ) and (4) the optimum intensity and duration of the programme.This study was designed to help inform
metformin 10520 diabetes. Our research question wereWhat is the evidence on cost-effectiveness of lifestyle programmes or metformin in diabetes prevention?What is the impact of the following factors on the cost-effectiveness of these
metformin 11532 undertaken in the last 10 years.[23] This paper is the first review to consider the cost-effectiveness of metformin and the first review to examine intervention-only and screening-plus-intervention studies separately.
metformin 12625 evaluation (cost-effectiveness, cost-utility or cost-benefit analysis) of (1) lifestyle programmes, (2) metformin or (3) screening in combination with lifestyle programmes and/or metformin against a base case of usual
metformin 12700 lifestyle programmes, (2) metformin or (3) screening in combination with lifestyle programmes and/or metformin against a base case of usual care or no intervention.10.1136/bmjopen-2017-017184.supp1Supplementary
metformin 12939 inclusion criteria, economic evaluations needed to haveevaluated the treatment of pre-diabetes with either metformin and/or lifestyle programmes (that addressed diet and physical activity);included ≥12 months of intervention
metformin 19922 results.[65]Type of interventionAll 27 studies evaluated lifestyle interventions and 12 also evaluated metformin (online supplementary appendix 2). Thirteen reported interventions in a population previously identified
metformin 26795 with results ranging from 4.2 to 30.MetforminEight studies measured change in QALYs associated with metformin therapy with a median of 0.105 (range: 0.01–2.83) increase in QALYs and five studies reported increase
metformin 27014 LYG with a median gain of 0.14 (range: 0.05–0.3). Two studies reported number needed to treat with metformin to prevent 1 case of type 2 diabetes as 6.9 and 27.9.Side effects of screening or interventionThe impact
metformin 27832 considered impact on equity of healthcare provision.Cost-effectivenessOverall, lifestyle interventions and metformin appeared to be cost effective in preventing diabetes in high-risk individuals, as summarised in table
metformin 30391 avoidedParticipant and healthcare professionals’ time23 18323 183Cost per case of T2DM avoidedICERs: metformin Metformin: ICER in 2015 GBP Health system perspectiveMetformin: ICER in 2015 GBP Societal perspectiveReferenceDuration
metformin 31471 Type 2 Diabetes Mellitus.There is insufficient evidence to suggest that lifestyle interventions or metformin will be cost saving. Out of 27 studies, lifestyle interventions were found to be cost saving in 2 studies
metformin 31815 study[47] and cost saving from a societal perspective in three studies.[52] Of the 12 studies evaluating metformin , 2 studies concluded metformin was cost saving from a health system perspective,[40] 1 study concluded
metformin 31846 societal perspective in three studies.[52] Of the 12 studies evaluating metformin, 2 studies concluded metformin was cost saving from a health system perspective,[40] 1 study concluded metformin was cost saving from
metformin 31928 studies concluded metformin was cost saving from a health system perspective,[40] 1 study concluded metformin was cost saving from a health system perspective in some countries but not others[47] and 2 concluded
metformin 32040 was cost saving from a health system perspective in some countries but not others[47] and 2 concluded metformin was cost saving from a societal perspective.[40]Lifestyle programmes appear to be cost effective. Of
metformin 33256 health system perspective was £8428/QALY (range: cost saving to £32 430/QALY). Two studies reported metformin to not be cost effective (costing >£20 000 per QALY): of these, one used a model substantially different
metformin 33587 model of the USDPP.[49] The subsequent models based on the USDPP and its follow-up study have found metformin to be cost saving or cost effective.[40]Twelve studies compared lifestyle programmes and metformin directly.
metformin 33686 metformin to be cost saving or cost effective.[40]Twelve studies compared lifestyle programmes and metformin directly. From a health system perspective, neither intervention appears more cost effective than the
metformin 33877 cost effective than the other with six studies reporting lifestyle programmes more cost effective than metformin ,[46] five studies[29] reporting metformin more cost effective than lifestyle programmes and one[62]
metformin 33919 studies reporting lifestyle programmes more cost effective than metformin,[46] five studies[29] reporting metformin more cost effective than lifestyle programmes and one[62] showing <1% difference in cost-effectiveness
metformin 34087 showing <1% difference in cost-effectiveness between the two. However, from a societal perspective, metformin appears more cost effective than lifestyle programmes, with four[40] out of the five studies undertaking
metformin 34224 than lifestyle programmes, with four[40] out of the five studies undertaking this analysis finding metformin more cost effective. This is because the cost of participants’ time travelling to and attending lifestyle
metformin 39837 (oral glucose tolerance test (OGTT)), 40% and 59% would participate in the lifestyle intervention and metformin , respectively. In total, 32% of these would develop diabetes in 3 years with no intervention and 9.3%
metformin 40003 diabetes in 3 years with no intervention and 9.3% and 28.8% would develop diabetes with lifestyle and metformin respectively which resulted in 0.2% of incident cases of diabetes being prevented by metformin and 0.8%
metformin 40098 and metformin respectively which resulted in 0.2% of incident cases of diabetes being prevented by metformin and 0.8% by lifestyle programmes. These rates of attendance and enrolment are based on best estimates,
metformin 48083 countries identified with the oral glucose tolerance test. Third, that with these caveats in mind, both metformin and lifestyle interventions in people with pre-diabetes appear to be cost effective but not cost saving
metformin 48813 report undiscounted cost-effectiveness ratios with only one of those appearing cost saving. Fourth, that metformin and lifestyle programmes appear equally cost effective when only the costs of the health system are
metformin 48947 appear equally cost effective when only the costs of the health system are taken into account, but metformin is more cost effective when costs of participants’ time (participating in and travelling to programme
metformin 50664 criteria to enable estimation of treatment effects. There is insufficient evidence to suggest that metformin is more cost effective than lifestyle programmes.Policymakers need to make decisions even when all the
metformin 53125 efficacy of these interventions. This review has added to previous work in three key areas: evaluation of metformin , comparison of screening-plus-intervention against intervention-only studies and consideration of the
metformin 54379 incidence will be important as, based on studies in this review, individual lifestyle programmes and metformin are unlikely to be sufficient to address the vast majority of incident cases of diabetes.ConclusionsNational
Select Disease Character Offset Disease Term Instance
metabolic syndrome 9178 BMI to the large trials but with different selection criteria (eg, selection based on elements of the metabolic syndrome rather than the criteria of IGT seen in the large trials).[19] There is some evidence that these pragmatic
metabolic syndrome 25700 and three used other methods of screening (such as diabetes risk algorithms, BMI or other elements of metabolic syndrome ).[41] Also, 17 out of 27 studies included participants based on a BMI ≥24 kg/m2, 3 included participants
obesity 4027 factors, including sedentary lifestyle and energy-rich, nutrient-poor diet, both of which predispose to obesity .[5]Diabetes takes a significant toll on health budgets around the world, accounting for 5%–20% of
obesity 52158 made in controlling the diabetes ‘epidemic’. These may include population-wide measures to address obesity , a primary determinant of progression to type 2 diabetes in a person with pre-diabetes.[92]Comparison

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