Cost-effectiveness of the psycho-educational blended (group and online) intervention HypoAware compared with usual care for people with Type 1 and insulin-treated Type 2 diabetes with problematic hypoglycaemia: analyses of a cluster-randomized controlled trial

Diabet Med. 2018 Feb;35(2):214-222. doi: 10.1111/dme.13548. Epub 2017 Dec 12.


Aims: To evaluate the cost-effectiveness of HypoAware, a blended (group and online) psycho-educational intervention based on the evidence-based Blood Glucose Awareness Training, in comparison with usual care in people with Type 1 and Type 2 diabetes with a high risk of severe hypoglycaemia.

Methods: We performed an economic evaluation, from a societal and healthcare perspective, that used data from a 6-month, multicentre, cluster-randomized controlled trial (n = 137).

Results: The proportion of people with at least one severe hypoglycaemic event per 6 months was 0.22 lower (95% CI -0.39 to -0.06) and the proportion of people with impaired hypoglycaemia awareness was 0.16 lower (95% CI -0.34 to 0.02) in the HypoAware group. There was no difference in quality-adjusted life-years (-0.0; 95% CI -0.05 to 0.05). The mean total societal costs in the HypoAware group were EUR708 higher than in the usual care group (95% CI -951 to 2298). The mean incremental cost per severe hypoglycaemic event prevented was EUR2,233. At a willingness-to-pay threshold of EUR20,000 per event prevented, the probability that HypoAware was cost-effective in comparison with usual care was 54% from a societal perspective and 55% from a healthcare perspective. For quality-adjusted life-years the incremental cost-effectiveness ratio was EUR119,360/quality-adjusted life-year gained and the probability of cost-effectiveness was low at all ceiling ratios.

Conclusions: Based on the present study, we conclude that HypoAware is not cost-effective compared to usual care. Further research in less well-resourced settings and more severely affected patients is warranted. (Clinical Trials Registry no: Dutch Trial Register NTR4538.).

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cluster Analysis
  • Cost-Benefit Analysis
  • Diabetes Mellitus, Type 1 / economics
  • Diabetes Mellitus, Type 1 / therapy*
  • Diabetes Mellitus, Type 2 / economics
  • Diabetes Mellitus, Type 2 / therapy*
  • Female
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemia / economics
  • Hypoglycemia / prevention & control
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / economics
  • Insulin / adverse effects
  • Insulin / economics
  • Internet / economics
  • Internet / statistics & numerical data
  • Male
  • Middle Aged
  • Patient Education as Topic / economics
  • Patient Education as Topic / methods*
  • Psychotherapy, Group / methods*
  • Treatment Outcome


  • Hypoglycemic Agents
  • Insulin