Prediabetes intervention may save $1 trillion over 10 years

Among the estimated 37 million people in the United States with undetected prediabetes meeting the American Diabetes Association (ADA) screening guidelines, detection and intervention could potentially prevent 9.5 million diabetes cases with gross national economic benefits of $991 billion over 10 years.

These are among the findings of microsimulation modeling undertaken by IHS to estimate disease onset, medical expenditures, economic outcomes, mortality, and quality of life for a nationally representative population sample with undiagnosed prediabetes meeting ADA screening guidelines. The findings were published in the March 2015 issue of the American Journal of Preventive Medicine. The IHS Disease Prevention Microsimulation Model (DPMM) focused on the economic benefits of lifestyle intervention programs designed to lower body weight and glycemic levels to prevent or delay the onset of type 2 diabetes and related chronic conditions.

Prediabetes is a widespread condition in which blood glucose levels are elevated but below the diabetic threshold. Prediabetic individuals are at high risk for developing type 2 diabetes, heart disease, and stroke, among other conditions. Notwithstanding its prevalence, approximately 90% of the 86 million prediabetes population remains undiagnosed. Identification, management, and, where possible, prevention of diabetes are increasingly viewed as critical public health goals.

The results of the modeling indicate that treating prediabetes through lifestyle changes far outweighs intervention costs over the analyzed 10-year period. Simulated medical savings per participant for those meeting diabetes screening criteria recommended by the ADA totaled $10,400-while estimated average cumulative gross economic benefits of treating each such patient amounted to $26,800-comfortably exceeding estimated screening costs ($18.50) and intervention costs (about $2,300).

Moreover, the cumulative benefits of intervention continue to grow over time. Among the ADA-identified population, average gross economic benefits were estimated to be $3,070, $10,500, and $26,800 within 2, 5, and 10 years, respectively.

The study also provides support for the value of intervention from the standpoint of medical outcomes. In the nonintervention scenario, nearly one-third of the prediabetes population (32.5%) developed diabetes within 10 years. Mortality reached 33.9%, and diabetes prevalence among those surviving at year 10 reached 36.4%. However, intervention reduced diabetes onset by 41%, stroke by 36%, congestive heart failure by 33%, and mortality by 20% over the 10-year period.

While they do not provide the same level of rigor as large, randomized clinical trials, microsimulation models such as DPMM can, in real time, use information from clinical trials and other sources to inform population outcomes far into the future in a risk-free environment and without the large financial and logistical challenges associated with clinical trials.

In the future, such models may be used to help guide the development of employee health programs, as data can be utilized to develop population profiles. By tying data to disease, companies may learn more effective ways to identify and seek treatment for employees with conditions such as prediabetes, reduce absenteeism, and improve productivity.

Tim Dallismanaging director, Life Sciences Consulting, IHS Economics