Boston, Mass., July 25, 2016– The Institute for Clinical and Economic Review (ICER) has released a Final Evidence Report and Meeting Summary titled Diabetes Prevention Programs: Comparative Clinical Effectiveness and Value. The Final Report reviews the comparative clinical effectiveness and value of CDC-recognized diabetes prevention programs (DPPs) and provides an in-depth review of the policy landscape for these interventions. The report includes a summary of votes taken during a public meeting of one of ICER’s core programs, the California Technology Assessment Forum (CTAF), as well as key policy recommendations stemming from discussion with a panel of experts during the meeting.
A key goal of ICER’s reports is to ensure that patients, providers, insurers, and policymakers have the information they need to support efforts to improve the quality and value of care. The Final Report is accompanied by an Action Guide, which highlights the report’s policy recommendations and provides external resources to support their implementation.
“Type 2 diabetes is a major health concern for patients and our health care system,” Steven D. Pearson, MD, MSc, President of ICER, reflected. “There are different approaches to designing and implementing programs to prevent diabetes, and we believe that the evidence review and policy recommendations in our Final Evidence Report will help guide health systems and other stakeholders in figuring out how to move forward based on the strongest evidence of effectiveness and overall value.”
The report reviews the evidence on three key DPP delivery models that were developed to improve the scalability of the individual, in-person counseling intervention studied in the original DPP clinical trial. The CTAF Panel took votes on each of the three models: in-person programs with group coaching, digital programs with human coaching, and digital programs with fully-automated coaching.In-person, group coaching
The CTAF Panel voted unanimously that in-person programs with group coaching have a net health benefit that is superior to that of usual care. Panel members noted that weight loss is an appropriate indicator of program success, and that even a relatively short, two-year delay in the onset of diabetes is meaningful and important to patients. When voting on the care value, a measure which incorporates comparative clinical effectiveness, incremental costs per outcomes achieved, contextual considerations, and added benefits or disadvantages of the intervention, a majority of members voted for a high value.
Digital, human coaching
A majority of Panel members voted that digital programs with human coaching offer a net health benefit superior to that of usual care. Half of the members determined that these programs represent an intermediate care value, primarily because of uncertainty due to the existence of fewer, lower-quality studies of this approach. This uncertainty was balanced with the potential advantages of this model for participants, including increased access to DPPs in geographic areas that have few in-person programs and the flexibility to access lessons on-demand.
Digital, fully-automated coaching
A majority of the Panel voted that evidence is not adequate to demonstrate a net health benefit of digital DPPs with fully-automated coaching due largely to an absence of long-term studies of program efficacy. The panel emphasized that the model may have potential benefits, including high scalability, but noted that further study is required to conclusively demonstrate that the model is as effective as programs with human coaches. Due to the “no” vote on clinical effectiveness, a value vote was not taken.
Following the votes on the evidence, the CTAF Panel was joined by a policy roundtable of experts in the field, including a patient representative who had previously participated in a DPP, payer representatives, and experts in clinical practice and public health. Based on this discussion, a number of key policy recommendations emerged. These recommendations are summarized briefly below and are explained in greater detail in the full report.
- Payers are encouraged to cover CDC-recognized DPPs in a variety of formats across all plans with no copay. Payers should establish pay-for-performance contracts with DPP providers based on patient participation, retention, and weight loss.
- Clinicians should screen eligible patients for prediabetes using established clinical measures. When prediabetes is identified, clinicians should immediately refer patients to a local or digital DPP.
- DPP Providers should apply for CDC recognition for their programs, and should tailor their programs to include culturally-appropriate curricula for diverse populations. DPP Providers should collaborate with payers in developing pay-for-performance reimbursement strategies.
The Final Evidence Report and Meeting Summary, which includes a detailed explanation of all of the policy recommendations, is available on the ICER website. The Final Evidence Report is accompanied by an action guide that provides resources to support implementation of the policy recommendations. A full video recording of the June 24, 2016 meeting is also available on the website.
The Institute for Clinical and Economic Review (ICER) is an independent non-profit research institute that produces reports analyzing the evidence on the effectiveness and value of drugs and other medical services. ICER’s reports include evidence-based calculations of prices for new drugs that accurately reflect the degree of improvement expected in long-term patient outcomes, while also highlighting price levels that might contribute to unaffordable short-term cost growth for the overall health care system.
ICER’s reports incorporate extensive input from all stakeholders and are the subject of public hearings through three core programs: the California Technology Assessment Forum (CTAF), the Midwest Comparative Effectiveness Public Advisory Council (Midwest CEPAC), and the New England Comparative Effectiveness Public Advisory Council (New England CEPAC). These independent panels review ICER’s reports at public meetings to deliberate on the evidence and develop recommendations for how patients, clinicians, insurers, and policymakers can improve the quality and value of health care. For more information about ICER, please visit ICER’s website.