R.G. Memelink 1, L. Hulshof 2. S. Verlaan 1, T.L. Feenstra 2, P.J.M. Weijs 1.
1 Department of Nutrition and Dietetics, Faculty of Health, Sport and Physical Activity, Amsterdam University of Applied Sciences. 2 Groningen Research Institute of Pharmacy, Faculty of Science and Engineering, University of Groningen.
Background. Effective management of type 2 diabetes with obesity through combined lifestyle interventions (CLI) can reduce disease load and healthcare costs. A novel, short-term CLI named “2Do” combines intensive exercise training with increased protein intake during weight loss, which showed effectiveness on body composition and glucose control in older adults with obesity and type 2 diabetes. The current study aimed to assess the cost-effectiveness of 2Do compared to care as usual (CAU).
Methods. The MICADO simulation model was used to provide long-term assessment of the intervention’s impact on the older Dutch population with type 2 diabetes and increased BMI. Cost-effectiveness was evaluated by estimating Quality-Adjusted Life Years (QALYs) and relating this to intervention costs. QALY-based return on investment (ROI) was estimated and impact of changes in different risk factors on long-term health outcomes was assessed.
Results. In a simulated population of 583,100 patients, the 2Do intervention showed QALY gains compared to CAU (0.17; discounted) over a 30-year period. The cost per QALY gained for 2Do was 5.658 euros, implicating an ROI of 7.8 : 1. Important health benefits included reduced BMI, systolic blood pressure and HbA1c levels, which were projected to lead a decrease in the cumulative incidence of microvascular (-9.8% for microalbuminuria, -10% for neuropathy, -18% for background-retinopathy) and macrovascular (-6.4% for acute myocardial infarction, -5.7% for cerebrovascular accident) complications compared to CAU.
Discussion/Conclusion. Using the 50k threshold that holds for persons with type 2 diabetes, 2Do is cost-effective compared to care as usual. Savings in treatment costs for diabetes complications were not included yet. Neither were additional health benefits included that may arise from preserved muscle mass during weight loss. Therefore, the 2Do intervention demonstrates excellent potential for improving health outcomes in older adults with type 2 diabetes and obesity.