CDC-RTI Diabetes Cost-Effectiveness Model


Contact: Dr Ping Zhang

Type: Type 2/ Pre-diabetes

Information last updated: Feb 2019 

Participated in following Mt Hood Diabetes Challenge Meetings: 2004, 2010, 2012 2014, 2018

Publicly accessible?: No

Continuing to be developed?: Yes

Funding source for model development: Centers for Disease Control and Prevention

Brief Overview:


The CDC-RTI Diabetes Cost-Effectiveness Model is a Markov simulation model of disease progression and cost-effectiveness for type 2 diabetes. The model has four modules: the main diabetes module, diabetes screening module, pre-diabetes module, and pre-diabetes screening module.The main diabetes module follows patients from diagnosis to either death or age 95 years and simulates development of diabetes related complications on three micro-vascular disease paths (nephropathy, neuropathy, and retinopathy) and two macro-vascular disease paths for diabetes screening and pre-diabetes. Model outcomes include disease complications, deaths, costs, and quality-adjusted life years (QALYs).


​In the model, progression between disease states is governed by transition probabilities that depend on risk factors—including glycemic level (measured by HbA1c levels), blood pressure, cholesterol, and smoking status—and duration of diabetes. Interventions affect the transition probabilities and resulting complications. For example, tight glycemic control lowers HbA1c, slowing progression on the micro-vascular complication paths. With slower progression, fewer micro-vascular complications occur, deaths are delayed, QALYs increase, and the costs of complications are reduced. The model has been used to estimate the cost-effectiveness of many interventions/policy/guidelines related to diabetes prevention and cares, including treatment interventions for patients with diagnosed diabetes, screening for undiagnosed diabetes and pre-diabetes, and identifying high risk populations and utilizing lifestyle modification and drug therapies for type 2 diabetes prevention.


Key Publications:


Hoerger, T.J., Segel, J.E., Zhang, P., and Sorensen, S.W. (2009). Validation of the CDC-RTI Diabetes Cost-Effectiveness Model. RTI Press publication No. MR-0013-0909. Research Triangle Park, NC: RTI International.


William H. Herman, MD, MPH; Thomas J. Hoerger, PhD; Michael Brändle, MD, MS; Katherine Hicks, MS; Stephen Sorensen, PhD; Ping Zhang, PhD; Richard F. Hamman, MD, DrPH; Ronald T. Ackermann, MD, MPH; Michael M. Engelgau, MD, MS; and Robert E. Ratner, MD. The Lifetime Cost-Utility of Lifestyle Intervention or Metformin for the Prevention of Type 2 Diabetes Mellitus.  Annals of Internal Medicine. 2005; 142:323-332.

Lin J, Zhuo X, Bardenheier B, Rolka DB, Gregg WE, Hong Y, Wang G, Albright A, Zhang P. Cost-effectiveness of the 2014 U.S. Preventive Services Task Force (USPSTF) Recommendations for Intensive Behavioural Counselling Interventions for Adults With Cardiovascular Risk Factors. Diabetes Care. 2017 May;40(5):640-646

Reference simulation

The values below are simulated Quality Adjusted life Years (QALYs) for a set of reference simulations