Delivering the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cost effectiveness analysis

Abstract

Objectives: To assess the long term clinical and cost effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) intervention compared with usual care in people with newly diagnosed type 2 diabetes.

Design: We undertook a cost-utility analysis that used data from a 12 month, multicentre, cluster randomised controlled trial and, using the Sheffield type 2 diabetes model, modelled long term outcomes in terms of use of therapies, incidence of complications, mortality, and associated effect on costs and health related quality of life. A further cost-utility analysis was also conducted using current "real world" costs of delivering the intervention estimated for a hypothetical primary care trust.

Setting: Primary care trusts in the United Kingdom.

Participants: Patients with newly diagnosed type 2 diabetes.

Intervention: A six hour structured group education programme delivered in the community by two professional healthcare educators.

Main outcome measures: Incremental costs and quality adjusted life years (QALYs) gained.

Results: On the basis of the data in the trial, the estimated mean incremental lifetime cost per person receiving the DESMOND intervention is pound209 (95% confidence interval - pound704 to pound1137; euro251, -euro844 to euro1363; $326, -$1098 to $1773), the incremental gain in QALYs per person is 0.0392 (-0.0813 to 0.1786), and the mean incremental cost per QALY is pound5387. Using "real world" intervention costs, the lifetime incremental cost of the DESMOND intervention is pound82 (- pound831 to pound1010) and the mean incremental cost per QALY gained is pound2092. A probabilistic sensitivity analysis indicated that the likelihood that the DESMOND programme is cost effective at a threshold of pound20 000 per QALY is 66% using trial based intervention costs and 70% using "real world" costs. Results from a one way sensitivity analysis suggest that the DESMOND intervention is cost effective even under more modest assumptions that include the effects of the intervention being lost after one year.

Conclusion: Our results suggest that the DESMOND intervention is likely to be cost effective compared with usual care, especially with respect to the real world cost of the intervention to primary care trusts, with reductions in weight and smoking being the main benefits delivered.

Fig 1 Cost effectiveness acceptability curves for the probability that the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme is more cost effective than usual care. The curves relate to the combined trial and long term modelling results, and are based on the cost of the DESMOND intervention during the trial and in the real world. The vertical dotted lines show the cost effectiveness acceptability thresholds of £20 000 per QALY and £30 000 per QALY

Fig 2 Cost effectiveness plane for the combined trial and “real world” costs of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme. Solid points represent incremental cost and QALY results (intervention arm minus control arm) from the probabilistic sensitivity analysis for each of the 500 samples. The dashed horizontal and vertical blue lines show the 95% confidence interval for the incremental costs and the 95% confidence interval for the incremental gains in quality adjusted life years. The blue curve is the 95% confidence ellipse. All points to the right of the diagonal dashed red line, or “frontier,” are cost effective at an acceptability threshold of £20 000 per quality adjusted life year