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

Abstract

ObjectivesPrevention 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.DesignCost-effectiveness analysis alongside randomised controlled trial.Setting44 general practices in Leicestershire, England.Participants880 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 measureIncremental 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.ResultsAfter 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.ConclusionsThe 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 numberISRCTN80605705.

Type 2 diabetes remission: economic evaluation of the DiRECT/Counterweight‐Plus weight management programme within a primary care randomized controlled trial

“…The costs of the intervention, and of routine care, are similar in many other studies [23,24]. For example, the standard care arm among people with prediabetes in the UK Let's Prevent trial had an annual mean non-inpatient health service cost of £437 and medication cost of £124 [24], which is similar to the control arm resource use in our study (£520 for non-inpatient healthcare services and £168 for primary medications; Table 3). As such, the present economic analysis is likely to be widely transferable to diabetes care elsewhere, at least within countries with similar healthcare systems.…”

Optimal Threshold of the Finnish Diabetes Risk Score (Findrisc) for Screening at-Risk Adults in an African Population in Southern Benin

“…WC was measured using a flexible, unstretched graduated measuring tape with an accuracy of 0.1 cm. The tape was placed midway between the last rib and the iliac crest [14]. The IDF thresholds: 94 cm for men and 80 cm for women were used to detect with abdominal obesity.…”

“…The total score of each subject (maximum of 21) provides the level of T2D risk. This total score were rank as followed: very low (<7), low (7-11), moderately high (12)(13)(14), high (15)(16)(17)(18)(19)(20) and very high.…”

“…This means that early identification of people at high risk of T2D is necessary to enable faster implementation of preventive measures in order to reduce risk [12,13]. The prevention of the disease is very cost-effective [14,15]. Fasting blood glucose, 2h oral glucose tolerance test (OGTT) and glycated hemoglobin levels (HbA1c) are the recommended methods for diabetes screening [16].…”

Let's Prevent Diabetes: from idea to implementation

“…The intervention was found to result in a net gain of 0.046 QALYs over three years at an overall cost of £168 per patient, with an incremental cost‐effectiveness ratio of £3643 and a probability of 86% of being cost‐effective at a willingness to pay threshold of £20 000 …”