Abstract
Aims/hypothesis Approximately 10% of total healthcare budgets worldwide are spent on treating diabetes and its complications, and budgets are increasing globally because of ageing populations and more expensive second-line medications. The aims of the study were to estimate the within-trial and lifetime cost-effectiveness of the weight management programme, which achieved 46% remissions of type 2 diabetes at year 1 and 36% at year 2 in the Diabetes Remission Clinical Trial (DiRECT).
Methods Within-trial analysis assessed costs of the Counterweight-Plus intervention in DiRECT (including training, programme materials, practitioner appointments and low-energy diet), along with glucose-lowering and antihypertensive medications, and all routine healthcare contacts. Lifetime cost per quality-adjusted life-year (QALY) was estimated according to projected durations of remissions, assuming continued relapse rates as seen in year 2 of DiRECT and consequent life expectancy, quality of life and healthcare costs.
Results Mean total 2 year healthcare costs for the intervention and control groups were 3036 pound and 2420 pound, respectively: an incremental cost of 616 pound (95% CI -45 pound, 1269) pound. Intervention costs (1411; pound 95% CI 1308 pound, 1511) pound were partially offset by lower other healthcare costs (796; pound 95% CI 150 pound, 1465) pound, including reduced oral glucose-lowering medications by 231 pound (95% CI 148 pound, 314) pound. Net remission at 2 years was 32.3% (95% CI 23.5%, 40.3%), and cost per remission achieved was 1907 pound (lower 95% CI: intervention dominates; upper 95% CI: 4212) pound. Over a lifetime horizon, the intervention was modelled to achieve a mean 0.06 (95% CI 0.04, 0.09) QALY gain for the DiRECT population and mean total lifetime cost savings per participant of 1337 pound (95% CI 674 pound, 2081) pound, with the intervention becoming cost-saving within 6 years.
Conclusions/interpretation Incorporating the lifetime healthcare cost savings due to periods of remission from diabetes and its complications, the DiRECT intervention is predicted to be both more effective (QALY gain) and cost-saving in adults with type 2 diabetes compared with standard care. This conclusion appears robust to various less favourable model scenarios, providing strong evidence that resources could be shifted cost-effectively to support achieving remissions with the DiRECT intervention.