Cost-effectiveness of flexible intensive insulin management to enable dietary freedom in people with Type 1 diabetes in the UK.
OBJECTIVE
To determine the cost-effectiveness of a structured treatment and teaching programme (STTP) combining dietary freedom with insulin adjustment for Type 1 diabetes.


METHODS
Incremental cost-effectiveness analysis based on effectiveness data from three RCTs in Germany, Austria, and Dose Adjustment for Normal Eating (DAFNE) in the UK, to model the long-term microvascular complications of Type 1 diabetes.


RESULTS
The STTP approach yields effectiveness gains at a lower cost compared with current standard practice for treatment of Type 1 diabetes. STTPs are likely to save 0.05 life years, yield 0.12 EuroQol 5 dimensions (EQ-5D) and 0.09 visual analogue scale (VAS) incremental quality-adjusted life years, and save approximately pound 2200 per patient treated discounted over 10 years.


CONCLUSIONS
Introducing STTPs as standard treatment for people with Type 1 diabetes in the UK may help to achieve the primary goal of the National Service Framework (NSF) for Diabetes by enabling individuals to manage their own lifestyle and condition. In doing so it could save valuable resources for the NHS and yield important morbidity and mortality gains.
Shearer
A
A
York Health Economics Consortium, University of York, Vanbrugh Way, Heslington, York, YO10 4NH , UK. as57@york.ac.uk
Bagust
A
A
Sanderson
D
D
Heller
S
S
Roberts
S
S
D001786:Blood Glucose / Q000378:metabolism; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000191:economics*; D003925:Diabetic Angiopathies; D003928:Diabetic Nephropathies / Q000517:prevention & control; D003929:Diabetic Neuropathies / Q000517:prevention & control; D004032:Diet; D006442:Glycated Hemoglobin / Q000031:analogs & derivatives* / Q000378:metabolism; D017048:Health Care Costs; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008390:Markov Chains; D008954:Models, Biological; D010353:Patient Education as Topic; D019057:Quality-Adjusted Life Years; D012648:Self Care / Q000191:economics; D012680:Sensitivity and Specificity
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C025617:glucosylated hemoglobin A