Economic Evaluation of Fasting Mimicking Diet Versus Standard Care in Diabetic Patients on Dual or Triple Medications at Baseline in the United States: A Cost-Utility Analysis

• Published in: Value in health 2025-01, Vol.28 (1), p.51-59
• Main Authors: Habka, Dany, Hsu, William C., Antoun, Joseph
• Format: Article
• Language: English
• Subjects: Blood Glucose - drug effects; Blood Glucose - metabolism; Cost-Benefit Analysis; cost-utility analysis; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - economics; Drug Therapy, Combination; economic evaluation; Fasting; Fasting Mimicking Diet; Female; Humans; Hypoglycemic Agents - economics; Hypoglycemic Agents - therapeutic use; Male; Middle Aged; Models, Economic; nutritional therapy; Quality of Life; Quality-Adjusted Life Years; type 2 diabetes; United States
• ISSN: 1098-3015; 1524-4733; 1524-4733
• DOI: 10.1016/j.jval.2024.08.003

According to most guidelines, dietary interventions are essential in the management of diabetes. Fasting has emerged as potential therapeutic regimes for diabetes. The proof-of-concept study and the fasting in diabetes treatment trial are the first to explore the clinical impact of the Fasting Mimicking Diet (FMD) in patients with type 2 diabetes mellitus. Their results showed that FMD cycles improve glycemic management and can be integrated into usual care complementary to current guidelines. This economic evaluation aims to assess the 10-year quality-of-life effects, cost implications, and cost-effectiveness of adding a 3-year FMD program to diabetes standard care in diabetic population on dual or triple medications at baseline from the perspective of the US payer. We constructed a microsimulation model in TreeAge using a published US-specific diabetes model. The model was populated using FMD effectiveness outcomes and publicly available clinical and economic data associated with diabetes complications, use of diabetes medications, hypoglycemia incidence, direct medical costs in 2021 USD, quality of life, and mortality. All benefits were discounted by 3%. This cost-utility analysis showed that the FMD program was associated with 11.4% less diabetes complications, 67.2% less overall diabetes medication use, and 45.0% less hypoglycemia events over the 10-year simulation period. The program generated an additional effectiveness benefit of 0.211 quality-adjusted life year and net monetary benefit of 41 613 USD per simulated patient. Thus, the FMD program is cost saving. These results indicate that the FMD program is a beneficial first-line strategy in T2DM management. •Diabetes is an epidemic in the United States, with over 34 million Americans suffering from the condition. Dietary interventions can safely and effectively reduce weight and improve glycemic control in diabetic patients. According to most guidelines, they are considered essential in the management of the disease. The periodic 5-day Fasting Mimicking Diet (FMD) can improve glycemic management in patients with type 2 diabetes and can be integrated into usual care complementary to current guidelines.•By targeting the root cause of type 2 diabetes, results from FMD clinical trials suggested a viable, nutrition-led intervention that enhances the effectiveness of the standard of care. This cost-utility study is the first to evaluate the costs and consequences of adding the FMD fasting nutri-technolo