Modeling and Economics

Decision makers need information on the long-term effects of diabetes interventions and policies because the health and economic effects of these interventions and policies often go beyond the intervention period. In addition, decision makers often want to choose interventions that offer the largest health benefit because they have limited heath care resources. Computer models can be used to simulate the long-term health and cost outcomes of diabetes interventions.

Modeling and Economic Studies

Economic and Financial Burden of Diabetes

Overall Objective: This study is designed to quantify the economic and financial burden of diabetes on people with the disease, as well as on the national health care system and society as a whole in the United States. It will also track changes in the economic and financial burden of diabetes over time.

Funding Agency:

• CDC

Selected Publications:

1. Zhuo X, Zhang P, Barker L, et al. The lifetime cost of diabetes and its implications for diabetes prevention. Diabetes Care. 2014;37(9):2557–2564. doi: 10.2337/dc13-2484.
2. Zhuo X, Zhang P, Kahn HS, et al. Change in medical spending attributable to diabetes: national data from 1987 to 2011. Diabetes Care. 2015;38(4):581–587. doi: 10.2337/dc14-1687.
3. Zhuo X, Zhang P, Hoerger TJ. Lifetime direct medical costs of treating type 2 diabetes and diabetic complications. Am J Prev Med. 2013;45(3):253–261. doi: 10.1016/j.amepre.2013.04.017.
4. Zhang P, Shrestha S. Estimating the costs of diabetes by episodes of care: promises and challenges. J Diabetes Complications. 2015;29(4):463–464. doi: 10.1016/j.jdiacomp.2015.03.003.
5. Li R, Barker LE, Shrestha S, et al. Changes over time in high out-of-pocket health care burden in U.S. adults with diabetes, 2001-2011. Diabetes Care. 2014;37(6):1629–1635. doi: 10.2337/dc13-1997.
6. Shrestha SS, Zhang P, Li R, et al. Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008. Diabetes Res Clin Pract. 2013;100(1):102–110. doi: 1016/j.diabres.2013.02.002.
7. Shrestha SS, Zhang P, Albright A, et al. Medical expenditures associated with diabetes among privately insured U.S. youth in 2007. Diabetes Care. 2011;34(5):1097–1101. doi: 10.2337/dc10-2177.
8. Shrestha SS, Zhang P, Barker L, et al. Medical expenditures associated with diabetes acute complications in privately insured U.S. youth. Diabetes Care. 2010;33(12):2617–2622. doi: 10.2337/dc10-1406.

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Synthesizing Evidence on Cost-Effectiveness of Interventions for Preventing Type 2 Diabetes and Managing Type 2 and Type 1 Diabetes by Conducting Systematic Reviews

Overall Objective: This study is designed to gather and analyze evidence from published literature on the cost-effectiveness of interventions for preventing type 2 diabetes and managing type 2 and type 1 diabetes. Cost-effectiveness evaluations can help clinical and public health policy decision makers set intervention priorities.

Funding Agency:

• CDC

Selected Publications:

1. Li R, Qu S, Zhang P, et al. Economic evaluation of combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: a systematic review for the Community Preventive Services Task Force. Ann Intern Med. 2015;163(6):452–460. doi: 10.7326/M15-0469.
2. Li R, Zhang P, Barker LE, Chowdhury FM, Zhang X. Cost-effectiveness of interventions to prevent and control diabetes mellitus: a systematic review. Diabetes Care. 2010;33(8):1872–1894. doi: 10.2337/dc10-0843.

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Assessing the Long-Term Cost-Effectiveness of Interventions for Preventing Type 2 Diabetes and Managing Type 2 and Type 1 Diabetes Using a Computer Simulation Model

Overall Objective: This study is designed to assess the long-term cost-effectiveness of interventions for preventing type 2 diabetes and managing type 2 and type 1 diabetes by using a computer simulation model. Cost-effectiveness evaluations can help clinical and public health policy decision makers set intervention priorities.

Funding Agency:

• CDC, DDT

Period of Funding: Ongoing

Contractor:

• RTI International

Selected Publications:

1. Hoerger TJ, Crouse WL, Zhuo X, Gregg EW, Albright AL, Zhang P. Medicare's intensive behavioral therapy for obesity: an exploratory cost-effectiveness analysis. Am J Prev Med. 2015;48(4):419–425.
2. Zhuo X, Zhang P, Kahn HS, Gregg EW. Cost-effectiveness of alternative thresholds of the fasting plasma glucose test to identify the target population for type 2 diabetes prevention in adults aged ≥45 years. Diabetes Care. 2013;36(12):3992–399.
3. Zhuo X, Zhang P, Selvin E, et al. Alternative A1c cutoff to identify persons with high-risk for diabetes prevention: a cost-effectiveness analysis. Am J Prev Med. 2012;42(4):374–381.
4. Zhuo X, Zhang P, Gregg E, et al. A nationwide community-based lifestyle program could delay or prevent type 2 diabetes cases and save $5.7 billion in 25 years. Health Aff (Millwood). 2012;31(1):50–60.
5. Hoerger TJ, Zhang P, Segel JE, Kahn HS, Barker LE, Couper S. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Diabetes Care. 2010;33(9):1933–1939.
6. Li R, Zhang P, Barker LE, Hoerger TJ. Cost-effectiveness of aspirin use among persons with newly diagnosed type 2 diabetes. Diabetes Care. 2010;33(6):1193–1199.
7. Hoerger TJ, Zhang P, Segel JE, Gregg EW, Narayan KM, Hicks KA. Improvements in risk factor control among persons with diabetes in the United States: evidence and implications for remaining life expectancy. Diabetes Res Clin Pract. 2009;86(3):225–232.
8. Hoerger T, Hicks KA, Sorensen S, et al. The cost-effectiveness of screening for prediabetes among overweight U.S. adults. Diabetes Care 2007;30:2874–2879.
9. Ackermann R, Marrero D, Hicks K, et al. An evaluation of cost-sharing to finance a diet and physical activity intervention to prevent diabetes. Diabetes Care. 2006;29(6):1237–1241.
10. Herman WH, Hoerger TJ, Brandle M, et al. The lifetime cost-utility of lifestyle intervention or metformin for the prevention of type 2 diabetes mellitus. Ann Intern Med. 2005;142:323–332.
11. Dabelea D, DeGroat J, Sorrelman C, et al. Diabetes in Navajo youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth study. Diabetes Care. 2009;32(suppl 2):S141–S147. doi: 10.2337/dc09-S206.

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