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Cost-effectiveness of a lifestyle intervention in preventing Type 2 diabetes

Published online by Cambridge University Press:  30 September 2011

Lisa Irvine ,
Garry R. Barton ,
Amy V. Gasper ,
Nikki Murray ,
Allan Clark ,
Tracey Scarpello  and
Mike Sampson
Lisa Irvine
Affiliation:
Health Economics Group, Norwich Medical School–University of East Anglia
Garry R. Barton
Affiliation:
Health Economics Group, Norwich Medical School–University of East Anglia
Amy V. Gasper
Affiliation:
University of Leicester Medical School
Nikki Murray
Affiliation:
Norfolk and Norwich University Hospitals Foundation Trust–NHS Clinical Research & Trials Unit, University of East Anglia
Allan Clark
Affiliation:
Norwich Medical School, University of East Anglia
Tracey Scarpello
Affiliation:
Norfolk and Norwich University Hospitals Foundation Trust–NHS Clinical Research & Trials Unit, University of East Anglia
Mike Sampson
Affiliation:
Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals Foundation Trust
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Abstract

Objectives: Previous research has suggested people with impaired fasting glucose (IFG) are less likely to develop Type 2 diabetes (T2DM) if they receive prolonged structured diet and exercise advice. This study examined the within-trial cost-effectiveness of such lifestyle interventions.

Methods: Screen-detected participants with either newly diagnosed T2DM or IFG were randomized 2:1 to intervention versus control (usual care) between February and December 2009, in Norfolk (UK). The intervention consisted of group based education, physiotherapy and peer support sessions, plus telephone contacts from T2DM volunteers. We monitored healthcare resource use, intervention costs, and quality of life (EQ-5D). The incremental cost per quality-adjusted life-year (QALY) gain (incremental cost effectiveness ratio [ICER]), and cost effectiveness acceptability curves (CEAC) were estimated.

Results: In total, 177 participants were recruited (118 intervention, 59 controls), with a mean follow-up of 7 months. Excluding screening and recruitment costs, the mean cost was estimated to be £551 per participant in the intervention arm, compared with £325 in the control arm. The QALY gains were –0.001 and –0.004, respectively. The intervention was estimated to have an ICER of £67,184 per QALY (16 percent probability of being cost-effective at the £20,000/QALY threshold). Cost-effectiveness estimates were more favorable for IFG participants and those with longer follow-up (≥4 months) (ICERs of £20,620 and £17,075 per QALY, respectively).

Conclusions: Group sessions to prevent T2DM were not estimated to be within current limits of cost-effectiveness. However, there was a large degree of uncertainty surrounding these estimates, suggesting the need for further research.

Keywords

Cost-effectivenessEconomic evaluationDiabetes preventionGroup educationPeer support
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 27 , Issue 4 , October 2011 , pp. 275 - 282
Copyright
Copyright © Cambridge University Press 2011

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