Economic evaluation of wearable fitness trackers versus metformin for preventing type 2 diabetes in the UK population

May combine two claims.

Lifestyle interventions, including dietary modifications and physical activity programs, are clinically effective and cost-effective in preventing and managing T2D.

“Recent systematic reviews and meta-analyses have demonstrated that lifestyle interventions, including dietary modifications and physical activity programs, are clinically effective and cost-effective in preventing and managing T2D [8,9].”

• cites [8] Radl K, Ianuale C, Boccia S. A systematic review of the cost-effectiveness of lifestyle modification as primary prevention intervention for type 2 diabetes mellitus. Epidemiol Biostat Public Health [Internet]. 2022 Jul 7 [cited 2024 Jul 4];10(2). Available from: https://riviste.unimi.it/index.php/ebph/article/view/18242 sourcePartly supported

  The Abstract and Discussion (p. 6) describe lifestyle changes as clinically effective and cost-effective for preventing type 2 diabetes. The review addresses primary prevention, however, not management of established T2D; its inclusion criteria exclude interventions combined with therapy. The management portion of the citing sentence is therefore unsupported by this source. (LLM, conf=0.90)

  Experimental — accuracy not yet measured
• cites [9] Rinaldi G, Hijazi A, Haghparast-Bidgoli H. Cost and cost-effectiveness of mHealth interventions for the prevention and control of type 2 diabetes mellitus: a systematic review. Diabetes Res Clin Pract. 2020;162: 108084. sourcePartly supported

  Section 1.3 reports clinical effectiveness of mHealth interventions for T2D prevention and management, and the Conclusion says that interventions with reported cost-effectiveness results were highly cost-effective. The review evaluates technology-based interventions, not dietary modifications and physical activity programs generally; its Discussion also says evidence for preventive mHealth interventions remains extremely limited. It therefore does not establish the claim for lifestyle interventions as a whole. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

Each year, 5-10% of people with prediabetes develop diabetes, while an equal proportion revert to normal blood sugar levels.

“It is estimated that each year, 5-10% of people with prediabetes will develop diabetes, while an equal proportion will revert to normal blood sugar levels [7].”

• cites [7] Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M, Prediabetes. A high-risk state for diabetes development. Lancet Lond Engl. 2012;379(9833):2279–90. sourcePartly supported

  The ‘Progression from prediabetes to diabetes’ section states that around 5–10% of people with prediabetes develop diabetes annually. The ‘Reversion to normoglycaemia’ section reports that reversion occurs, but gives rates over other follow-up periods; it does not establish that an equal proportion reverts each year. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

Type 2 diabetes is preventable and can be delayed with lifestyle or medical interventions.

“Despite the increasing prevalence of T2D in the UK, it is preventable and can be delayed with lifestyle or medical interventions [2,3].”

• cites [2] Hemmingsen B, Gimenez-Perez G, Mauricio D, Roqué I, Figuls M, Metzendorf MI, Richter B. Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus. Cochrane Metabolic and Endocrine Disorders Group, editor. Cochrane Database Syst Rev [Internet]. 2017 Dec 4 [cited 2024 Jul 4];2017(12). Available from: https://doi.org/10.1002/14651858.CD003054.pub4 sourcePartly supported

  The Authors’ Conclusions (Implications for practice; page unavailable) find that diet plus physical activity reduces or delays type 2 diabetes in people with impaired glucose tolerance. The discussion of pharmacological interventions says some findings suggest progression from prediabetes is reduced or perhaps only delayed, but notes that their preventive use is not generally accepted. The claim omits these population and uncertainty qualifiers. (LLM, conf=0.82)

  Experimental — accuracy not yet measured
• cites [3] Madsen KS, Chi Y, Metzendorf MI, Richter B, Hemmingsen B. Metformin for prevention or delay of type 2 diabetes mellitus and its associated complications in persons at increased risk for the development of type 2 diabetes mellitus. Cochrane Metabolic and Endocrine Disorders Group, editor. Cochrane Database Syst Rev [Internet]. 2019 Dec 3 [cited 2024 Jul 4];2019(12). Available from: https://doi.org/10.1002/14651858.CD008558.pub2 sourceNot checked — no full text of the source

May combine two claims.

The Diabetes Prevention Program demonstrated cost-effectiveness, but its reliance on in-person coaching and frequent monitoring sessions poses challenges for widespread implementation.

“For example, the Diabetes Prevention Program (DPP) demonstrated costeffectiveness [14,15] but its reliance on in-person coaching and frequent monitoring sessions poses challenges for widespread implementation in resource-constrained healthcare systems like the NHS.”

• cites [14] McManus E. Evaluating the long-term cost-effectiveness of the English NHS Diabetes Prevention Programme using a Markov model. PharmacoEconomics - Open [Internet]. 2024 Apr 20 [cited 2024 Jul 4]; Available from: https://link.springer.com/https://doi.org/10.1007/s41669-024-00487-6 sourcePartly supported

  The Abstract conclusion finds the English NHS DPP likely to be cost-effective. The Discussion (Main Findings) describes the US DPP’s frequent individual and face-to-face visits and cautions that its trial results may not translate to the NHS programme. It does not conclude that those visits or monitoring pose a barrier to widespread implementation in resource-constrained NHS settings, nor does it evaluate the US DPP’s cost-effectiveness. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [15] Frempong SN, Shinkins B, Howdon D, Messenger M, Neal RD, Sagoo GS. Early economic evaluation of an intervention to improve uptake of the NHS England diabetes prevention programme. Expert Rev Pharmacoecon Outcomes Res. 2022;22(3):417–27. sourcePartly supported

  The Introduction describes the NHS programme as involving face-to-face sessions over at least nine months and reports low uptake and unmet participation targets. The Conclusion discusses how the NHS programme could remain cost-effective with an intervention to improve uptake. Neither passage establishes that the US DPP’s frequent monitoring sessions hinder widespread implementation in the NHS, and the paper’s economic evaluation concerns improving uptake of the NHS programme rather than demonstrating the US DPP’s cost-effectiveness. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

May combine two claims.

Other models in the same longitudinal study reported stronger effects (e.g., HR = 0.56), which would have yielded a more favourable estimate (HR = 0.77) for the same step increase.

“Other models in the same study reported stronger effects (e.g., HR = 0.56), which would have yielded a more favourable estimate (HR = 0.77) for the same step increase.”

• cites [26] Perry AS, Annis JS, Master H, Nayor M, Hughes A, Kouame A, et al. Association of longitudinal activity measures and diabetes risk: an analysis from the National Institutes of Health All of Us research program. J Clin Endocrinol Metab. 2023;108(5):1101–9. sourcePartly supported

  Table 2 (labeled Conclusions; page unavailable) reports an HR of 0.56 for 10,690 versus 5,970 mean daily steps in the age-, sex-, and race-adjusted model. The paper does not report an HR of 0.77 for a smaller step increase; that figure is the citing authors’ proposed recalculation, not a result stated in the source. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

May combine two claims.

Recent reviews have highlighted the effectiveness of fitness trackers in increasing physical activity levels and improving health outcomes related to chronic disease management.

“Recent reviews have highlighted their effectiveness in increasing physical activity levels and improving health outcomes related to chronic disease management [17,18].”

• cites [17] Baskerville R, Ricci-Cabello I, Roberts N, Farmer A. Impact of accelerometer and pedometer use on physical activity and glycaemic control in people with type 2 diabetes: a systematic review and meta‐analysis. Diabet Med. 2017;34(5):612–20. sourceNot checked — no full text of the source
• cites [18] Mattison G, Canfell O, Forrester D, Dobbins C, Smith D, Töyräs J, et al. The influence of wearables on health care outcomes in chronic disease: systematic review. J Med Internet Res. 2022;24(7):e36690. sourcePartly supported

  The Results section, “Theoretical Aspects of Wearables in Improving Health Care Outcomes” (page not provided), reports positive primary outcomes in 15 of 30 studies. But only 5 of 30 studies found a positive impact on physical activity, and the review says there was no strong relationship between wearables and improved physical activity. The claim therefore overstates the review’s findings on increasing activity. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

A systematic review of meta-analyses concludes that interventions using wearable devices increased step counts on average by around 1800 steps per day, walking time by about 40 minutes per day, and MVPA by nearly 6 minutes per day.

“A systematic review of meta-analyses concludes that interventions using wearable devices increased step counts on average by around 1800 steps per day, walking time by about 40 min per day, and MVPA by nearly 6 min per day [25].”

• cites [25] Ferguson T, Olds T, Curtis R, Blake H, Crozier AJ, Dankiw K, et al. Effectiveness of wearable activity trackers to increase physical activity and improve health: A systematic review of systematic reviews and meta-analyses. Lancet Digit Health. 2022;4(8):e615–26. sourceSupported

May combine two claims.

Metformin is a highly effective and widely adopted intervention for both managing T2D and preventing its onset in high-risk individuals.

“Metformin is a highly effective and widely adopted intervention for both managing type 2 diabetes (T2D) and preventing its onset in high-risk individuals [20,27].”

• cites [20] Patel D, Ayesha IE, Monson NR, Klair N, Patel U, Saxena A et al. The effectiveness of metformin in diabetes prevention: A systematic review and meta-analysis. Cureus [Internet]. 2023 Sep 28 [cited 2024 Jul 4]; Available from: https://www.cureus.com/articles/186969-the-effectiveness-of-metformin-in-diabetes-prevention-a-systematic-review-and-meta-analysis sourcePartly supported

  The Abstract reports a 42% lower risk of developing T2DM with metformin, and the Conclusions describe it as a valuable prevention intervention for high-risk populations. The Introduction calls metformin an oral antidiabetic drug, but the passages do not establish that it is highly effective for managing existing T2D or widely adopted for either purpose. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [27] Sáenz Calvo A, Fernández Esteban I, Mataix Sanjuán A, Ausejo Segura M, Roqué M, Moher D. Metformin for type 2 diabetes mellitus: systematic review and meta-analysis. Aten Primaria. 2005;36(4):183–91. sourcePartly supported

  The paper’s “Lo conocido sobre el tema” and “Qué aporta este estudio” sections describe metformin as a first-line treatment for type 2 diabetes and report beneficial effects on blood glucose. They discuss preventing vascular complications in people who already have diabetes, not preventing the onset of diabetes in high-risk individuals. Page numbers are unavailable for these passages. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Fitness trackers motivate users to move more throughout the day, and increased physical activity levels mitigate the risk of various chronic diseases, particularly T2D.

“By providing real-time feedback and personalised goals, fitness trackers motivate users to move more throughout the day, and the increased physical activity levels mitigate the risk of various chronic diseases, particularly T2D, where a sedentary lifestyle is a significant risk factor [16].”

• cites [16] Cavallo FR, Golden C, Pearson-Stuttard J, Falconer C, Toumazou C. The association between sedentary behaviour, physical activity and type 2 diabetes markers: A systematic review of mixed analytic approaches. Pegoraro C, editor. PLOS ONE. 2022;17(5):e0268289. sourcePartly supported

  The Results section (‘Diabetes incidence’) reports that three of four studies found higher odds of diabetes with more sedentary time, supporting the T2D-risk portion of the citation. The paper studies activity and diabetes markers, not whether fitness trackers’ real-time feedback or personalised goals motivate users to move more. It also does not establish that tracker-driven activity reduces the risk of various chronic diseases. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

As wearable device costs continue to fall, fitness trackers may become a scalable and cost-effective option for disease prevention in LMICs.

“As wearable device costs continue to fall, fitness trackers may become a scalable and cost-effective option for disease prevention in LMICs, where the burden of non-communicable diseases such as diabetes is growing rapidly [61].”

• cites [61] Asogwa OA, Boateng D, Marzà-Florensa A, Peters S, Levitt N, van Olmen J, et al. Multimorbidity of non-communicable diseases in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open. 2022;12(1):e049133. sourceSupported

• AssumptionRests on an assumption: Wearable device costs will continue to fall.

May combine two claims.

A four-state model structure was adopted because it has been clinically validated and used in several studies in the UK context.

“We adopted a four-state model structure: normal state (NGT), prediabetes state (PreD)/type 2 diabetes (T2D), and death (D) as it has been clinically validated and used in several studies in the UK context [14,15,21,30].”

• cites [14] McManus E. Evaluating the long-term cost-effectiveness of the English NHS Diabetes Prevention Programme using a Markov model. PharmacoEconomics - Open [Internet]. 2024 Apr 20 [cited 2024 Jul 4]; Available from: https://link.springer.com/https://doi.org/10.1007/s41669-024-00487-6 sourceSupported
• cites [15] Frempong SN, Shinkins B, Howdon D, Messenger M, Neal RD, Sagoo GS. Early economic evaluation of an intervention to improve uptake of the NHS England diabetes prevention programme. Expert Rev Pharmacoecon Outcomes Res. 2022;22(3):417–27. sourcePartly supported

  The Methods and Model Description sections describe the four states—normoglycaemia, prediabetes, type 2 diabetes, and death—in this NHS England evaluation. Methods also refers to previous model-based evaluations, but our copy does not say the structure was clinically validated or establish that several UK studies used it. No page number is available in the indexed passages. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [21] Roberts S, Craig D, Adler A, McPherson K, Greenhalgh T. Economic evaluation of type 2 diabetes prevention programmes: Markov model of low- and high-intensity lifestyle programmes and metformin in participants with different categories of intermediate hyperglycaemia. BMC Med. 2018;16(1):16. sourcePartly supported

  The Methods and Validation sections (pages not provided) describe a four-state model, verification with a clinical team in East London, and expert testing of the model structure’s face validity. The Discussion says previous economic evaluations commonly used Markov models, but it does not establish that several UK studies used this particular four-state structure. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [30] Palmer AJ, Roze S, Valentine WJ, Spinas GA, Shaw JE, Zimmet PZ. Intensive lifestyle changes or Metformin in patients with impaired glucose tolerance: modeling the long-term health economic implications of the diabetes prevention program in Australia, France, Germany, Switzerland, and the United Kingdom. Clin Ther. 2004;26(2):304–21. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The study's comprehensive modelling approach follows best practice guidance.

“Another strength of this study is our comprehensive modelling approach following the best practice guidance [31].”

• cites [31] Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, et al. Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BMC Med. 2022;20(1):23. sourcePartly supported

  The CHEERS 2022 statement (Background, ‘The CHEERS 2022 statement’; page unavailable) says its guidance applies to studies based on mathematical modelling. It also distinguishes reporting quality from the quality of a study’s conduct. It therefore supports citing guidance relevant to reporting a modelling study, but not the claim that this study’s modelling approach followed best practice in its conduct. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A reverse transition from T2D back to prediabetes was not included, to align with common practices, because this reversion is rare and unlikely to have a meaningful impact on cost-effectiveness over a lifetime horizon.

“We did not include a reverse transition from T2D back to prediabetes to be aligned with common practices in previous studies [29] as this reversion is rare and unlikely to have a meaningful impact on cost-effectiveness over a lifetime horizon.”

• cites [29] Leal J, Morrow LM, Khurshid W, Pagano E, Feenstra T. Decision models of prediabetes populations: a systematic review. Diabetes Obes Metab. 2019;21(7):1558–69. sourceSupported

• AssumptionThe authors state this as an assumption: Reversion from T2D back to prediabetes is rare and unlikely to have a meaningful impact on cost-effectiveness over a lifetime horizon.

Classified as probably not a substantial claim.

Incremental effects from Herman et al. (2005) were used because they have been used in the most recent studies in the UK context.

“Table 6 presents the incremental effects from Herman et al. (2005) as they have been used in the most recent studies in the U.K. context [14,21].”

• cites [14] McManus E. Evaluating the long-term cost-effectiveness of the English NHS Diabetes Prevention Programme using a Markov model. PharmacoEconomics - Open [Internet]. 2024 Apr 20 [cited 2024 Jul 4]; Available from: https://link.springer.com/https://doi.org/10.1007/s41669-024-00487-6 sourcePartly supported

  Methods > Sensitivity Analyses (page not available) uses US DPP trial data identified as a parameter source in Herman et al. (2005) for an alternative diabetes-transition scenario. It does not say that recent UK studies used Herman’s incremental effects, or provide those effects as such. (LLM, conf=0.79)

  Experimental — accuracy not yet measured
• cites [21] Roberts S, Craig D, Adler A, McPherson K, Greenhalgh T. Economic evaluation of type 2 diabetes prevention programmes: Markov model of low- and high-intensity lifestyle programmes and metformin in participants with different categories of intermediate hyperglycaemia. BMC Med. 2018;16(1):16. sourcePartly supported

  In Methods > Model parameters (page unavailable), Table 2 shows incremental utility effects used in this England-based model. It attributes those utilities to NICE guidance [32], not directly to Herman et al. (2005), and does not establish that Herman’s effects were used across recent UK studies. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Markov model was implemented in Microsoft Excel, following best practices for health economic modelling from conceptualisation to validation.

“The Markov model was implemented in Microsoft Excel, following best practices for health economic modelling from conceptualisation to validation [31] (See supplementary materials for CHEERS checklist).”

• cites [31] Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, et al. Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BMC Med. 2022;20(1):23. sourcePartly supported

  The CHEERS 2022 statement (Background, ‘The CHEERS 2022 statement’; page unavailable) provides a reporting checklist applicable to modelling studies, supporting the reference to a CHEERS checklist. It explicitly limits the checklist to assessing reporting rather than the quality of a study’s conduct. It therefore does not establish that implementing this Markov model in Excel followed best practices from conceptualisation through validation. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

A cycle length of one year was chosen, in line with similar studies in the UK context.

“We chose a cycle length of one year, in line with similar studies in the UK context [14,21].”

• cites [14] McManus E. Evaluating the long-term cost-effectiveness of the English NHS Diabetes Prevention Programme using a Markov model. PharmacoEconomics - Open [Internet]. 2024 Apr 20 [cited 2024 Jul 4]; Available from: https://link.springer.com/https://doi.org/10.1007/s41669-024-00487-6 sourceSupported
• cites [21] Roberts S, Craig D, Adler A, McPherson K, Greenhalgh T. Economic evaluation of type 2 diabetes prevention programmes: Markov model of low- and high-intensity lifestyle programmes and metformin in participants with different categories of intermediate hyperglycaemia. BMC Med. 2018;16(1):16. sourceSupported

Classified as probably not a substantial claim. May combine two claims.

A lifetime time horizon was chosen because it is aligned with best practices and is needed to capture all health effects and costs for chronic conditions like T2D.

“We chose the lifetime as the time horizon for the costeffectiveness analysis.This choice was aligned with the best practices as a long-time horizon is needed to capture all the health effects and costs pertained to chronic conditions like T2D [34].”

• cites [34] Siebert U, Alagoz O, Bayoumi AM, Jahn B, Owens DK, Cohen DJ, et al. State-transition modeling: A report of the ISPOR-SMDM modeling good research practices task Force–3. Value Health J Int Soc Pharmacoeconomics Outcomes Res. 2012;15(6):812–20. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The burden of non-communicable diseases such as diabetes is growing rapidly in LMICs.

“where the burden of non-communicable diseases such as diabetes is growing rapidly [61]”

• cites [61] Asogwa OA, Boateng D, Marzà-Florensa A, Peters S, Levitt N, van Olmen J, et al. Multimorbidity of non-communicable diseases in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open. 2022;12(1):e049133. sourceSupported

The quote only partly states this claim.

With a lower discount rate of 1.5% for outcomes and costs, fitness trackers remained dominant, yielding an incremental NMB of £5,003.96 per patient.

“In this case, fitness trackers remained dominant, yielding an incremental NMB of £5,003.96per patient.”

May combine two claims.

Patients using wearable fitness trackers gained an average of 17.27 QALYs, compared with 17.11 QALYs for those on metformin, an additional 0.15 QALYs per patient.

“In terms of health benefits, patients using wearable fitness trackers gained an average of 17.27 QALYs, compared with 17.11 QALYs for those on metformin, resulting in an additional 0.15 QALYs per patient.”

May combine two claims.

Over a 10-year time horizon, fitness trackers were dominant over metformin, yielding an incremental NMB of £2,033.51 per patient at the £20,000 per QALY willingness-to-pay threshold.

“Similar to the base case, the fitness trackers were shown to be dominant over metformin, yielding an incremental NMB of £2,033.51per patient at the £20,000 WTP threshold.”

• Also stated in: § Principal findings · hedged

  “Over a shorter 10-year time horizon, which may be more relevant to budget-holders, fitness trackers remained dominant, with a positive incremental NMB of £2,033.51.”

May combine two claims.

In the optimistic time-varying scenario, the incremental NMB dropped to £2,602.10 per patient, but fitness trackers remained a dominant strategy.

“Under these assumptions, the incremental NMB dropped to £2,602.10 per patient, nevertheless, the fitness trackers remained a dominant strategy.”

• AssumptionThe authors state this as an assumption: Metformin's preventive effect remains stable for the first 15 years and disappears thereafter.
• AssumptionThe authors state this as an assumption: In the optimistic scenario, the effect of fitness trackers is maintained for 5 years, then gradually wanes and disappears by year 10.

May combine two claims.

Over a lifetime horizon, the wearable fitness tracker intervention was associated with an average cost of £59,710.68 per patient, while metformin cost £60,388.32, a per-patient cost saving of £678 in favour of the fitness tracker.

“Over a lifetime horizon, the wearable fitness tracker intervention was associated with an average cost of £59,710.68 per patient, while the metformin cost £60,388.32.This represents a per-patient cost saving of £678 in favour of the fitness tracker.”

May combine two claims.

The maximum economically justifiable price for a fitness tracker is £440 per year, or £1,233 per device assuming a device lifespan of 3 years at a 3.5% discount rate.

“The maximum economically justifiable price for a fitness tracker is £440 per year, or £1,233 per device assuming a device lifespan of 3 years at the pre-specified discount rate of 3.5%.”

May combine two claims.

Wearable fitness trackers are likely to be a cost-effective, and in many scenarios dominant, intervention for preventing T2D in individuals with prediabetes, offering both health benefits and cost savings compared to metformin.

“This study found that wearable fitness trackers are likely to be a cost-effective, and in many scenarios dominant, intervention for preventing T2D in individuals with prediabetes, offering both health benefits and cost savings compared to metformin.”

Classified as probably not a substantial claim.

The effectiveness of fitness trackers depends heavily on individual engagement and adherence over time.

“However, unlike pharmaceutical interventions, where outcomes are relatively more predictable, the effectiveness of fitness trackers depends heavily on individual engagement and adherence over time.”

May combine two claims.

Fitness trackers are a cost-effective and scalable option for T2D prevention in the UK, offering good value even under conservative assumptions.

“Fitness trackers are a cost-effective and scalable option for T2D prevention in the UK, offering good value even under conservative assumptions.”

• Also stated in: § Principal findings · hedged

  “This economic evaluation demonstrated that wearable fitness trackers are likely to be a cost-effective and, in many scenarios, dominant strategy compared to metformin for preventing T2D in individuals with prediabetes.”

May combine two claims.

Wearable fitness trackers were a dominant strategy compared with metformin, being both more effective and less costly.

“In the base case, wearable fitness trackers were a dominant strategy, yielding higher quality-adjusted life years (QALYs) at lower costs than metformin.”

• Also stated in: § Base case · plain

  “Since the wearable fitness trackers were both more effective and less costly than metformin, it was a dominant strategy.”

• Also stated in: § Principal findings · plain

  “In the base case analysis, the fitness trackers intervention resulted in both lower costs and greater effectiveness, with an incremental NMB of £3,722.07 per patient at the WTP threshold of £20,000 per QALY as recommended by NICE [28].”

Classified as probably not a substantial claim.

Fitness trackers function as more independent, self-directed interventions with less behavioural scaffolding than structured lifestyle programmes like the NHS DPP.

“Compared to structured lifestyle intervention programmes like the NHS DPP, fitness trackers function as more independent, self-directed interventions with less behavioural scaffolding such as coaching and regular support that is built into programmes like the DPP.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Digital health technologies have demonstrated clinical effectiveness and cost-effectiveness in managing T2D.

“While digital health technologies have demonstrated clinical effectiveness and cost-effectiveness in managing T2D [10][11][12] their role in preventing T2D remains less well-explored.”

• cites [10][11][12]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

The authors deliberately chose the most conservative adjusted estimate to avoid overstating the intervention's benefit and ensure a cautious modelling approach.

“We deliberately chose the most conservative adjusted estimate to avoid overstating the intervention's benefit and ensure a cautious modelling approach.”

May combine two claims.

The omission of a separate T2D with complications state may have led to an underestimation of the full benefits of prevention, strengthening the cost-effectiveness findings.

“Moreover, since the burden of complications is embedded within the T2D health state, this approach may have led to an underestimation of the full benefits of prevention-therefore strengthening our cost-effectiveness findings.”

Probably not a substantial claim: may not pass S2 (checkable).

Using metformin as a benchmark allows decision-makers to make a practical and meaningful assessment of the relative value of fitness trackers as a non-pharmacological alternative for diabetes prevention.

“Using metformin as a benchmark, allowing decision-makers to make a practical and meaningful assessment of the relative value of fitness trackers as a non-pharmacological alternative for diabetes prevention.”

Classified as probably not a substantial claim.

Health state costs were chosen from the source most commonly used in the UK context, which included costs for screening for the normal and prediabetes states and costs for treatment and management of the T2D state.

“Although there are multiple sources of health state costs according to McManus' (2024) review, we chose the one most commonly used in the UK context [46]which included costs for screening for the normal and the prediabetes state and costs for the treatment and management of the T2D state.”

• cites [46] Hex N, Bartlett C, Wright D, Taylor M, Varley D. Estimating the current and future costs of type 1 and type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabet Med J Br Diabet Assoc. 2012;29(7):855–62. sourceNot checked — no full text of the source

May combine two claims.

The fixed cost simplification likely results in a conservative estimate, and the true cost savings may be even greater.

“Since the fitness tracker intervention delays progression to T2D, this simplification likely results in a conservative estimate, and the true cost savings may be even greater.”

• AssumptionRests on an assumption: In reality, costs are likely to increase over time, particularly in the T2D state due to complications.

Classified as probably not a substantial claim.

The choice of a lifetime horizon for the base case analysis aligns with best practices in health economic evaluation, capturing the long-term benefits and costs associated with preventing T2D.

“choice of a lifetime horizon for the base case analysis aligns with best practices in health economic evaluation, capturing the long-term benefits and costs associated with preventing T2D.”

Classified as probably not a substantial claim.

Transition probabilities were obtained from a literature review, prioritising meta-analyses, randomised controlled trials, and UK national statistics where possible.

“The parameter values were obtained from literature review.Where possible, we prioritised meta-analyses, randomised controlled trials, and data from UK national statistics.”

May combine two claims.

The study conducted both deterministic and probabilistic sensitivity analyses, ensuring robust results that account for a range of uncertainties across key parameters.

“We conducted both deterministic and probabilistic sensitivity analyses, ensuring robust results that account for a range of uncertainties across key parameters.”

Classified as probably not a substantial claim.

The study included a 10-year horizon scenario, which adds practical value for policymakers concerned with short-to medium-term planning and resource allocation.

“In addition, we included a 10-year horizon scenario, which adds practical value for policymakers concerned with short-to medium-term planning and resource allocation.”

Classified as probably not a substantial claim.

The study provides a direct economic comparison between a digital health intervention (fitness trackers) and a widely established pharmacological treatment (metformin).

“First, it provides a direct economic comparison between a digital health intervention (fitness trackers) and a widely established pharmacological treatment (metformin) [3,20,51,53].”

Probably not a substantial claim: may not pass S3 (load-bearing).

The study followed established best practices by presenting both scenarios as part of a structured sensitivity analysis.

“We followed established best practices by presenting both scenarios as part of a structured sensitivity analysis [28].”

• cites [28] NICE. 7 Incorporating economic evaluation| Developing NICE guidelines: The manual [Internet]. NICE. 2014 [cited 2023 Feb 23]. Available from: https://www.nice.org.uk/process/pmg20/chapter/incorporating-economic-evaluationNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

With appropriate targeted provisions for underserved populations, wearable fitness trackers could form a scalable and equitable component of national diabetes prevention strategies-not only in the UK but also in low-and middle-income countries.

“With appropriate targeted provisions for underserved populations, wearable fitness trackers could form a scalable and equitable component of national diabetes prevention strategies-not only in the UK but also in low-and middle-income countries.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Without targeted subsidies or provision for disadvantaged populations, large-scale rollout of this intervention could unintentionally widen health inequalities.

“Without targeted subsidies or provision for disadvantaged populations, large-scale rollout of this intervention could unintentionally widen health inequalities.”