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Background: Non-communicable diseases, including diabetes, presents a great burden in developing and developed world, especially in older adults and seniors. In Europe, approximately 9% of the adults have diabetes. In 2017 the diabetes-related costs in Sweden was $ 8 356/capita. Health Economic Evaluations indicates great health- and economic burden due to type 2 diabetes, which is the most common obesity-related comorbidity. Dietary habits and body weight plays an important role in the question which dietary pattern best addresses glycaemia, weight control, and cardiovascular risk factors. Individuals following a vegetarian and vegan diet have lower levels of cholesterol and body mass index, which consequentially decrease the risk of diabetes.

Aim: The objective of this study was to estimate the cost-effectiveness of type 2 diabetes prevention initiative targeting decreasing risk of developing type 2 diabetes with a plant-based diet, in individuals in prediabetic states, by comparing a hypothetical plant-based diet intervention versus a lifestyle intervention in Diabetes Prevention Program.

Methods: Markov model with states prediabetes, diabetes, and death is applied. It is modelled from a societal perspective for a 10-year time horizon. Utility units are expressed in Quality Adjusted Life Years (QALYs), and costs in USD ($) at 2018 inflation rate. A 3% discount rate is applied on both costs and benefits, to reflect the time preference of the society on future investments. The incremental cost-effectiveness ratio (ICER) per QALY gained was calculated to show whether the hypothetical Plant-based Diet program is cost-effective, compare to Lifestyle Diabetes Prevention Program.

Results: Incremental cost-effectiveness ratios identify Plant-based Diet as pricier with a cost of $ 89 956, but it also yielded QALYs of 6.72. The lifestyle DPP brings 5.63 QALYs for the cost of $ 88 560. The incremental effect recognizes 1.08 higher QALY of Plant-based Diet over Lifestyle Diabetes Prevention Program. The Plant-based intervention yielded grater QALYs in this analysis, with and ICER cost per QALY of $ 1 297.

Conclusion: Plant-based Diet Program yield greater health benefits and cost-effectiveness compared to Lifestyle Diabetes Prevention Program. Yet, further research is needed to gather more accurate data to validate the effectiveness.