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Randomized Controlled Trial
. 2019 Nov 11;19(1):824.
doi: 10.1186/s12913-019-4529-8.

Cost-effectiveness of the SLIMMER diabetes prevention intervention in Dutch primary health care: economic evaluation from a randomised controlled trial

Geerke Duijzer  1   2 , Andrea J Bukman  3 , Aafke Meints-Groenveld  3 , Annemien Haveman-Nies  3   4   5 , Sophia C Jansen  4 , Judith Heinrich  4 , Gerrit J Hiddink  6 , Edith J M Feskens  3 , G Ardine de Wit  7   8
Affiliations
Randomized Controlled Trial

Cost-effectiveness of the SLIMMER diabetes prevention intervention in Dutch primary health care: economic evaluation from a randomised controlled trial

Geerke Duijzer et al. BMC Health Serv Res. .

Abstract

Background: Although evidence is accumulating that lifestyle modification may be cost-effective in patients with prediabetes, information is limited on the cost-effectiveness of interventions implemented in public health and primary health care settings. Evidence from well-conducted pragmatic trials is needed to gain insight into the realistic cost-effectiveness of diabetes prevention interventions in real-world settings. The aim of this study is to assess the cost-effectiveness of the SLIMMER lifestyle intervention targeted at patients at high risk of developing type 2 diabetes compared with usual health care in a primary care setting in the Netherlands.

Methods: Three hundred and sixteen high-risk subjects were randomly assigned to the SLIMMER lifestyle intervention or to usual health care. Costs and outcome assessments were performed at the end of the intervention (12 months) and six months thereafter (18 months). Costs were assessed from a societal perspective. Patients completed questionnaires to assess health care utilisation, participant out-of-pocket costs, and productivity losses. Quality Adjusted Life Years (QALY) were calculated based on the SF-36 questionnaire. Cost-effectiveness planes and acceptability curves were generated using bootstrap analyses.

Results: The cost-effectiveness analysis showed that the incremental costs of the SLIMMER lifestyle intervention were €547 and that the incremental effect was 0.02 QALY, resulting in an incremental cost-effectiveness ratio (ICER) of €28,094/QALY. When cost-effectiveness was calculated from a health care perspective, the ICER decreased to €13,605/QALY, with a moderate probability of being cost-effective (56% at a willingness to pay, WTP, of €20,000/QALY and 81% at a WTP of €80,000/QALY).

Conclusions: The SLIMMER lifestyle intervention to prevent type 2 diabetes had a low to moderate probability of being cost-effective, depending on the perspective taken.

Trial registration: The SLIMMER study is retrospectively registered with ClinicalTrials.gov (Identifier NCT02094911) since March 19, 2014.

Keywords: Cost-effectiveness; Diabetes; Economic evaluation; Lifestyle intervention; Prevention.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the SLIMMER randomised controlled trial, for cost-effectiveness analyses
Fig. 2
Fig. 2
Cost-effectiveness acceptability curve of the SLIMMER intervention compared to usual health care, from a societal perspective
Fig. 3
Fig. 3
Cost-effectiveness acceptability curve of the SLIMMER intervention compared to usual health care, from a health care perspective
See this image and copyright information in PMC

References

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