Including Dementia in Economic Analyses of Diabetes Prevention Program Has Little Effect

Adding dementia to an existing economic model evaluating lifestyle interventions to prevent diabetes and cardiovascular disease was feasible but did not affect policy recommendations or economic outcomes, according to a study published online in Medical Decision Making. 

“Guidelines for the development of cost-effectiveness analyses for public health interventions recommend that disease outcomes that do not affect the cost-effectiveness outcomes can be excluded from model structures,” wrote researchers from the University of Sheffield and University of Cambridge in the United Kingdom. “In this study, including dementia did not alter the recommendations for the intervention or substantially affect the health economic outcomes. As such, these analyses did not provide a compelling argument to routinely include dementia in public health models for lifestyle interventions.” 

Researchers adapted a diabetes prevention model describing an individual’s risk of type 2 diabetes, microvascular outcomes, cardiovascular disease, congestive heart failure, cancer, osteoarthritis, depression, and mortality in England to include dementia. They then estimated dementia’s impact on cost-effectiveness outcomes of the National Health Service diabetes prevention program (NHS DPP) in three scenarios: (1) no dementia as a health outcome; (2) dementia only as a health outcome; and (3) reduced dementia risk as a health outcome. 

In the no-dementia scenario, lifetime cost savings per patient were £145, according to the study. Meanwhile, lifetime cost savings of the National Health Service diabetes prevention program were £121 in the dementia-only scenario, and £167 in the reduced dementia risk scenario.

Gains in quality-adjusted life years grew 0.0006 in the dementia-only scenario and 0.0134 in the reduced dementia risk scenario, researchers reported. Adding dementia did not alter the cost-effectiveness of the National Health Service diabetes prevention program. 

“The impact on health economic outcomes was largest,” researchers wrote, “where a direct impact on dementia incidence was assumed, particularly in elderly populations.” 

—Jolynn Tumolo 

Reference

Breeze P, Thomas C, Thokala P, Lafortune L, Brayne C, Brennan A. The Impact of Including Costs and Outcomes of Dementia in a Health Economic Model to Evaluate Lifestyle Interventions to Prevent Diabetes and Cardiovascular Disease [published online ahead of print, 2020 Sep 19]. Med Decis Making. 2020;272989X20946758. doi:10.1177/0272989X20946758