Economic implications of IGT intervention: the case of a "phantom alternative'?
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Diabetes is a major chronic disease (or group of diseases). It is associated with a variety of risk factors which promote its occurrence. It is also associated as a risk factor for structural and function damage (complications) in various body systems, especially the cardiovascular, renal, eye and neurological systems. Undoubtedly, diabetes is a disease of major public health importance, both in terms of its impact on the well-being of the population and its economic burden. It is thus natural to look into interventions aimed at reducing the long-term sequelae of the disease or more specifically looking into primary prevention strategies (i.e., interventions prior to the onset of the disease) and their economic implications. The purpose of this paper is to asses whether it is possible to perform economic evaluation of primary prevention strategy(ies) in subject with IGT or whether such a strategy represents, at present, a 'Phantom Alternative'. Unfortunately, the evidence about the effectiveness of primary prevention type interventions are weak at best. It is not surprising that no one has suggested a comprehensive strategy (i.e., who is doing what, to whom, where and how often) for an intervention for subjects with impaired glucose tolerance (IGT). The absence of good evidence about the effectiveness of different IGT interventions preclude a valid economic analysis. 'What-it' or 'modelling' type studies are likely to result in the typical answer-'it depends'. It is recommended, therefore, that an economic evaluation should be performed in conjunction with a clinical trial to determine the effectiveness of different IGT interventions.
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