Applications of the RE-AIM framework also recommend
understanding the costs of intervention delivery in terms of
reach and effectiveness [7]. To date, determining the costeffectiveness
of diabetes prevention has been tied solely to
information gleaned from the outcomes of the DPP trial
[8–11]. In nearly every case, translational diabetes prevention
trials in the United States were adapted to reflect the DPP key
elements using a lower frequency of sessions (e.g., 11 to 16
sessions), typically delivered to groups rather than to individuals
[12–20]. These adaptations are made as a method to
reduce intervention costs, but only three studies reported cost
explicitly and those that do have simply reported on the cost of
the intervention rather than on cost-effectiveness in achieving
outcomes [13,18,21]. Studies that determine the relationships
between reach, effectiveness and cost of diabetes prevention
programs delivered in typical clinical or community settings
are needed.