title: Cost effectiveness of group follow-up after structured education for type 1 diabetes: a cluster randomised controlled trial.
abstract: BACKGROUND
  This study examines the cost effectiveness of group follow-up after participation in the Dose Adjustment for Normal Eating (DAFNE) structured education programme for type 1 diabetes.
  
  
  METHODS
  Economic evaluation conducted alongside a cluster randomised controlled trial involving 437 adults with type 1 diabetes in Ireland. Group follow-up involved two group education 'booster' sessions post-DAFNE. Individual follow-up involved two standard one-to-one hospital clinic visits. Incremental costs, quality-adjusted life years (QALYs) gained and cost effectiveness were estimated at 18 months. Uncertainty was explored using sensitivity analysis and by estimating cost effectiveness acceptability curves.
  
  
  RESULTS
  Group follow-up was associated with a mean reduction in QALYs gained of 0.04 per patient (P value, 0.052; 95% CI, -0.08 to 0.01, intra-class correlation (ICC), 0.033) and a mean reduction in total healthcare costs of €772 (P value, 0.020; 95% CI, -1,415 to -128: ICC, 0.016) per patient. At alternative threshold values of €5,000, €15,000, €25,000, €35,000, and €45,000, the probability of group follow-up being cost effective was estimated to be 1.000, 0.762, 0.204, 0.078, and 0.033 respectively.
  
  
  CONCLUSIONS
  The results do not support implementation of group follow-up as the sole means of follow-up post-DAFNE. Given the reported cost savings, future studies should explore the cost effectiveness of alternative models of group care for diabetes.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN79759174 (assigned: 9 February 2007).
authors.affiliation: School of Business and Economics, J,E, Cairnes Building, NUI Galway, Galway, Ireland. paddy.gillespie@nuigalway.ie.
authors.forename: Paddy
authors.initials: P
authors.lastname: Gillespie
authors.forename: Eamon
authors.initials: E
authors.lastname: O'Shea
authors.forename: Mary Clare
authors.initials: MC
authors.lastname: O'Hara
authors.forename: Sean F
authors.initials: SF
authors.lastname: Dinneen
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000191:economics* / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000191:economics* / Q000379:methods*; D019057:Quality-Adjusted Life Years; D012107:Research Design