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.
OBJECTIVE
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.


METHODS
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.


METHODS
Primary care trusts in the United Kingdom.


METHODS
Patients with newly diagnosed type 2 diabetes.


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


METHODS
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.


CONCLUSIONS
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.
Gillett
M
M
School of Health and Related Research (ScHARR), University of Sheffield, Sheffield. m.gillett@sheffield.ac.uk
Dallosso
H M
HM
Dixon
S
S
Brennan
A
A
Carey
M E
ME
Campbell
M J
MJ
Heller
S
S
Khunti
K
K
Skinner
T C
TC
Davies
M J
MJ
D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000191:economics / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000191:economics*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012648:Self Care / Q000191:economics*; D016896:Treatment Outcome
D006442:Glycated Hemoglobin