Cost-effectiveness analysis of a digital Diabetes Prevention Program (dDPP) in prediabetic patients

Objectives To assess the cost-effectiveness of a digital Diabetes Prevention Program (dDPP) in preventing type 2 diabetes mellitus among prediabetic patients from a health system perspective over a 10-year time horizon. Methods A Markov cohort model was constructed to assess the cost-effectiveness of dDPP compared to a small group education (SGE) intervention. Transition probabilities for the first year of the model were derived from two clinical trials on dDPP. Transition probabilities for longer-term effects were derived from meta-analyses on lifestyle and Diabetes Prevention Program interventions. Cost and health utilities were derived from published literature. Partial completion of interventions was incorporated to provide a robust prediction of a real-world deployment. Parameter uncertainties were assessed using univariate and probabilistic sensitivity analyses. Cost-effectiveness was measured by an incremental cost-effectiveness ratio (ICER) between dDPP and SGE from a health system perspective over a 10-year time horizon. Results The dDPP dominated the SGE at the $50,000, $100,000, and $150,000 willingness-to-pay thresholds per quality-adjusted life years (QALYs). The base case analysis at the $100,000 willingness-to-pay threshold (WTP) revealed a dominated ICER, with the SGE costing $1332 more and accruing an average of 0.04 fewer QALYs. Probabilistic sensitivity analysis showed that the dDPP was preferred in 64.4% of simulations across the $100,000 WTP thresholds. Conclusions The findings comparing a dDPP to an SGE suggest that a dDPP can be cost-effective for patients with a high risk of developing type 2 diabetes.