Estimation of the Effects and Costs of Lifestyle Intervention and Treatment With Voglibose in the Japanese Prediabetic Population: A Cost-Effectiveness Analysis.

Objectives: Prediabetes is a condition in which blood glucose levels are higher than normal but not high enough for a type 2 diabetes (T2DM) diagnosis. Lifestyle and pharmacological interventions, such as voglibose, an alpha-glucosidase inhibitor that reduces postprandial hyperglycemia, can address pathophysiological deficits in prediabetes. In Japan, voglibose is approved for preventing T2DM in patients with impaired glucose tolerance. We evaluated the cost-effectiveness of a lifestyle intervention alone and a combined intervention (lifestyle + voglibose) in extending quality-adjusted diabetes-free life years (QADFLY) and the associated costs in the Japanese prediabetic population.

Methods: We developed a Markov microsimulation model to replicate the natural history of a theoretical cohort of the Japanese prediabetic population. Transition probabilities were derived from the results of current clinical practices regarding prediabetes. Health outcomes were measured in the number of QADFLYs gained. Model robustness was addressed through one-way sensitivity analysis. The costs and QADFLYs were discounted at a rate of 2% per year.

Results: In the base case, the lifestyle intervention cost $4969 with 3.976 QADFLYs, compared with $5407 and 4.274 QADFLYs for the combined intervention. Prediabetic individuals in Japan would spend an additional $1469 to gain one more QADFLY when voglibose is added to lifestyle intervention.

Conclusions: The combined intervention is cost-effective, leading to more patients achieving normal glucose tolerance and fewer progressing to T2DM compared with lifestyle changes alone. In the Japanese prediabetic population, combining lifestyle changes with voglibose should be considered an effective strategy for preventing T2DM.