Targeting all eligible patients would be cost-effective, but cost might be reduced by focusing on certain patient subgroups.
The 2014 U.S. Preventive Services Task Force (USPSTF) recommendation for behavioral counseling interventions for adults with cardiovascular disease (CVD) risk factors would be cost effective based on the conventional cost-effectiveness threshold, according to the results of a study published recently in Diabetes Care.
The study estimated that the intervention would cost approximately $13,900 per quality-adjusted life year (QALY).
“We estimate that under the new USPSTF recommendation on behavioral counseling for CVD prevention, ~98 million Americans are eligible for the intervention, which would cost $64 billion if all were to participate,” wrote Ji Lin, of the division of diabetes translation at the Centers for Disease Control and Prevention, and colleagues. “Applying the conventional ‘willingness-to-pay’ cutoff of $50,000/QALY, the intervention is cost effective for the overall targeted population as well as for each age group.”
In August 2014, the USPSTF released a recommendation for intensive behavioral counseling to reduce CVD risks in overweight or obese adults with one or more of these risk factors: hypertension, dyslipidemia, impaired fasting glucose or metabolic syndrome. The intervention would be delivered by trained professionals and would include a healthy diet and physical activity, individual feedback, problem-solving skills and an individualized plan.
With this study, Li and colleagues assessed the long-term cost effectiveness of the implementation of this intervention in the United States. Using a disease progression model, they simulated the 25-year cost-effectiveness of the recommendation for all eligible U.S. adults and subgroups.
Breaking down the data
A baseline population was estimated using data from the 2005 to 2012 National Health and Nutrition Examination Surveys. They estimated that approximately 98 million U.S. adults (44%) would be eligible for the recommended intervention. At a cost of $653 per person, implementing this recommendation would cost about $64 billion. However, without the intervention, the total cost of treatment and intervention per person would by $54,872 over 25 years.
Over a period of 25 years, the incremental cost effectiveness ratio (ICER) of the intervention was $13,900 per QALY.
“Our results are consistent with those of previous studies that found intensive lifestyle interventions aimed at reducing the incidence of type 2 diabetes among people with prediabetes to be cost effective, with a median cost of approximately $14,000/QALY gained,” the researchers wrote.
Researchers also examined the cost effectiveness of the intervention across a variety of patient subgroups. The ICER varied greatly among subgroups from $3,400 per QALY for overweight adults with impaired fasting glucose with both dyslipidemia and hypertension to $33,800 per QALY for overweight adults with impaired fasting glucose without those additional comorbidities. The ICER was as high as $103,200 per QALY for patients who were overweight but did not have impaired fasting glucose, dyslipidemia or hypertension, but did have metabolic syndrome.
The researchers estimated that focusing on obese adults with at least one additional risk factor and overweight adults with impaired fasting glucose would reduce the intervention-eligible population to about 66.7 million and lower the cost of the intervention by about $20 billion.
“Further refinement of recommendations for risk stratification, and focusing on a group only delivery method with comparable effectiveness, may improve the cost effectiveness of the intervention,” Lin and colleagues concluded.