Cost-utility analysis of lifestyle interventions to prevent type 2 diabetes in women with prior gestational diabetes

Amber Werbrouck, Masja Schmidt, Koen Putman, Lieven Annemans, Katrien Benhalima, Steven Simoens, Nick Verhaeghe

Research output: Contribution to journalArticle


BACKGROUND: To compare estimated costs and health outcomes of lifestyle interventions for the prevention of type 2 diabetes mellitus in women who had gestational diabetes.

METHODS: An age-specific Markov model was applied comparing costs and quality-adjusted life years (QALYs) of three alternatives: 'doing nothing'; an annual reminder system (ARS) with an awareness campaign ('ARS-awareness'); and an ARS with an intensive lifestyle intervention ('ARS-ILS'). A healthcare payer perspective was adopted, the time horizon was 30 years and the setting was Flanders (Belgium). Sensitivity analyses were performed.

RESULTS: 'ARS-awareness' was extendedly dominated. Per 10 000 participants, 'ARS-ILS' cost €13 210 256 more and gained 496 QALYs compared with 'doing nothing' (26 632 €/QALY), with a 63% probability of being cost effective, given a cost effectiveness threshold of 35 000 €/QALY. A scenario analysis showed that 'ARS-ILS' for 15 years only offered to women with prediabetes (compared with 'doing nothing') has an 89.5% likelihood of being dominant.

CONCLUSIONS: 'ARS-ILS' may be the preferred intervention. However, the probability of being cost effective was low. Based on further scenario analyses, we recommend healthcare decision makers to consider the application of a more intensive alternative, focused on the highest risk profiles and with a shorter intervention duration.

Original languageEnglish
Pages (from-to)396-401
Number of pages6
JournalEuropean Journal of Public Health
Issue number3
Publication statusPublished - 1 Jun 2020

Bibliographical note

© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.


  • Cost-utility analysis
  • lifestyle interventions
  • prevention
  • type 2 diabetes
  • women
  • prior gestational diabetes

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