Running Title: Cost effectiveness of prevention of diabetes Communication:

Cost effectiveness of prevention of diabetes Objective: In Indian Diabetes Prevention Program (IDPP), a 3 year randomized control trial, life style modification (LSM) and metformin (Met) helped to prevent type 2 diabetes in subjects with impaired glucose tolerance (IGT). The direct medical cost and cost effectiveness of the interventions relative to the control group are reported here. Research design and methods: Relative effectiveness and costs of interventions (LSM, Met and LSM +Met) in IDPP were estimated, from the health care system perspective. Costs of intervention considered were only the direct medical costs.. Direct non medical, indirect and research costs were excluded. Cost effectiveness of interventions were measured as the amount spent on preventing one case of diabetes within the 3year trial period. Results: Direct medical cost to identify one subject with IGT was INR 5,278 ($117). Direct medical costs of interventions over the 3 year trial period were INR 2739 ($61) per subject in the control, INR 10,136 ($225) with LSM, INR 9,881 ($220) with Met and INR 12,144 ($270) with LSM + Met. Number needed to treat to prevent a case of diabetes was 6.4 with LSM, 6.9 with Met and 6.5 with LSM + Met. Cost-effectiveness of preventing one case of diabetes in LSM, Met and LSM + Me