Cost-effectiveness of a Pragmatic Structured Education Intervention for the Prevention of Type 2 Diabetes: Economic Evaluation of Data From the Let's Prevent Diabetes Cluster-Randomised Controlled Trial

BMJ Open. 2017 Jan 9;7(1):e013592. doi: 10.1136/bmjopen-2016-013592.

Abstract

Objectives: Prevention of type 2 diabetes mellitus (TD2M) is a priority for healthcare systems. We estimated the cost-effectiveness compared with standard care of a structured education programme (Let's Prevent) targeting lifestyle and behaviour change to prevent progression to T2DM in people with prediabetes.

Design: Cost-effectiveness analysis alongside randomised controlled trial.

Setting: 44 general practices in Leicestershire, England.

Participants: 880 participants with prediabetes randomised to receive either standard care or a 6-hour group structured education programme with follow-up sessions in a primary care setting.

Main outcome measure: Incremental cost utility from the UK National Health Service (NHS) perspective. Quality of life and resource use measured from baseline and during the 36 months follow-up using the EuroQoL EQ-5D and 15D instruments and an economic questionnaire. Outcomes measured using quality-adjusted life years (QALYs) and healthcare costs calculated in 2012-2013 prices.

Results: After accounting for clustering and missing data, the intervention group was found to have a net gain of 0.046 (95% CI -0.0171 to 0.109) QALYs over 3 years, adjusted for baseline utility, at an additional cost of £168 (95% CI -395 to 732) per patient compared with the standard care group. The incremental cost-effectiveness ratio is £3643/QALY with an 86% probability of being cost-effective at a willingness to pay threshold of £20 000/QALY.

Conclusions: The education programme had higher costs and higher quality of life compared with the standard care group. The Let's Prevent programme is very likely to be cost-effective at a willingness to pay threshold of £20 000/QALY gained.

Trial registration number: ISRCTN80605705.

Keywords: DIABETES & ENDOCRINOLOGY; HEALTH ECONOMICS; PREVENTIVE MEDICINE; PRIMARY CARE.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Cost-Benefit Analysis
  • Diabetes Mellitus, Type 2 / economics*
  • Diabetes Mellitus, Type 2 / prevention & control
  • Female
  • Health Expenditures
  • Health Resources / economics
  • Health Resources / statistics & numerical data
  • Healthy Lifestyle
  • Hospitalization / economics
  • Humans
  • Hypoglycemic Agents / economics
  • Hypoglycemic Agents / therapeutic use
  • Male
  • Patient Education as Topic
  • Quality of Life
  • Quality-Adjusted Life Years

Substances

  • Hypoglycemic Agents

Associated data

  • ISRCTN/ISRCTN80605705