Aims: Follow-up of the Counterweight-Plus intervention in DiRECT has demonstrated 6.1 kg weight loss and 10 % remissions from type 2 diabetes at 5 years. We previously reported cost-effectiveness based on 2-year results. We now present an updated cost-effectiveness analysis, based on available 5-year data.
Methods: A lifetime cost-effectiveness analysis was conducted using the 5-year data from DiRECT, including time to relapse from remission from type 2 diabetes, intervention costs (practitioner appointment visits, low-energy formula diet sachets), routine healthcare resource use (primary, secondary, and tertiary care contacts), medications (anti-hypertensive and anti-diabetic medicines), and quality of life (EuroQol EQ-5D-3L). Modelling assumed that all those in remission at 5 years would relapse after a maximum of 10 years.
Results: Total (discounted) healthcare cost-savings (excluding intervention costs) per participant over 5 years amounted to £2091. On average, healthcare costs per annum were ~£480 per participant lower in the intervention arm (p < 0.05). Intervention resource use beyond 2 years added relatively little to the total intervention cost (set-up, formula diet and practice visits), which amounted to £1691 (95% CI: £1566, 1822) per participant over 5 years. Reduced hospital admissions accounted for the major part of this saving, with the remainder being across primary and secondary care, and anti-diabetic and anti-hypertensive medications. Remission in DiRECT was associated with a significant improvement in quality of life, and the intervention arm was modelled to achieve both cost-savings of ~£400 and quality adjusted life year gains of 0.043 over 5 years, with further benefits due to reduced mortality in remission. Over the full lifetime horizon of the analysis the intervention was modelled to produce 0.08 incremental QALYs, saving £496 per participant.
Conclusions: The costs involved in achieving remissions from type 2 diabetes with the Counterweight-Plus diet programme were offset within 5 years through reduced healthcare resource use. Though remission may ultimately relapse, sustained weight loss brings other longer term health gains. The intervention, even using one-to-one face-to-face contacts rather than remote delivery, which is increasingly adopted, generated both health gains and cost-savings compared with current best practice.
Keywords: diabetes; economics; type 2 diabetes.
© 2026 The Author(s). Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.