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The cost-effectiveness of metformin in the US diabetes prevention program trial: Simple interpretations need not apply.

Authors :
Rittenhouse BE
Alolayan S
Eguale T
Segal AR
Doucette J
Source :
Preventive medicine [Prev Med] 2024 Jan; Vol. 178, pp. 107819. Date of Electronic Publication: 2023 Dec 11.
Publication Year :
2024

Abstract

Based on previously published US Diabetes Prevention Program (DPP) cost-effectiveness analyses (CEAs) metformin continues to be promoted as "cost-effective." We review the DPP within-trial CEA to assess this claim. Treatment alternatives included placebo (plus standard lifestyle advice), branded metformin and individual lifestyle modification. We added generic metformin as an alternative. Original published CEA data were taken as given and re-analyzed according to accepted principles for calculating incremental cost-effectiveness ratios (ICERs) in the economic evaluation field. With more than two treatments as in the DPP, these require attention to the rankings of interventions according to cost or effect prior to stipulating appropriate ICERs to calculate. With proper ICERs neither branded nor generic metformin was cost-effective, regardless of the value assumed for the willingness to pay for the quality-adjusted life year outcome assessed. Metformin alternatives were technically inefficient compared to placebo or the lifestyle modification alternative. Net loss calculations indicated substantial costs/health losses to using metformin instead of the optimal lifestyle alternative in response to metformin having been inaccurately labelled "cost-effective" in the original CEA. That CEA and subsequent analyses and citations of such analyses continue to claim that both metformin and lifestyle modification are cost-effective in diabetes prevention based on DPP data. Using metformin implies substantial costs and health losses compared to the cost-effective lifestyle modification. It may be that metformin has a role in cost-effective diabetes prevention, but this has yet to be shown based on DPP data.<br />Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.<br /> (Copyright © 2023. Published by Elsevier Inc.)

Details

Language :
English
ISSN :
1096-0260
Volume :
178
Database :
MEDLINE
Journal :
Preventive medicine
Publication Type :
Academic Journal
Accession number :
38092328
Full Text :
https://doi.org/10.1016/j.ypmed.2023.107819