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August 10, 2011

Exercise Interventions and Glycemic Control in Patients With Diabetes

Author Affiliations

Author Affiliation: Hubert Department of Global Health, Emory University, Atlanta, Georgia (dfwilli@sph.emory.edu).

JAMA. 2011;306(6):607-610. doi:10.1001/jama.2011.1106

To the Editor: Dr Pahor made a sound case for insurers to seriously consider reimbursing for physical activity and exercise programs delivered to patients with diabetes.1 Unfortunately, his assessment of the economic value of lifestyle intervention programs to prevent diabetes may be misleading.

Based on a mathematical modeling study by Eddy et al,2 Pahor suggested that from an insurer's perspective, the lifetime cost-effectiveness of the Diabetes Prevention Program (DPP) lifestyle intervention is $143 000 per quality-adjusted life-year. This estimate, however, used the very high annual cost of the lifestyle program ($1365 per participant) as implemented in the DPP research trial in which the intervention was delivered to individual participants in a 1:1 format. Pahor did not report the estimate by Eddy et al of lifetime cost-effectiveness when the annual cost of the intervention was reduced to $217 per participant by delivering the intervention to groups rather than individuals. In this case the cost-effectiveness is only $27 000 per quality-adjusted life-year.

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