title: Cost-effectiveness of intensive multifactorial treatment compared with routine care for individuals with screen-detected Type 2 diabetes: analysis of the ADDITION-UK cluster-randomized controlled trial.
abstract: OBJECTIVE
  To examine the short- and long-term cost-effectiveness of intensive multifactorial treatment compared with routine care among people with screen-detected Type 2 diabetes.
  
  
  METHODS
  Cost-utility analysis in ADDITION-UK, a cluster-randomized controlled trial of early intensive treatment in people with screen-detected diabetes in 69 UK general practices. Unit treatment costs and utility decrement data were taken from published literature. Accumulated costs and quality-adjusted life years (QALYs) were calculated using ADDITION-UK data from 1 to 5 years (short-term analysis, n = 1024); trial data were extrapolated to 30 years using the UKPDS outcomes model (version 1.3) (long-term analysis; n = 999). All costs were transformed to the UK 2009/10 price level.
  
  
  RESULTS
  Adjusted incremental costs to the NHS were £285, £935, £1190 and £1745 over a 1-, 5-, 10- and 30-year time horizon, respectively (discounted at 3.5%). Adjusted incremental QALYs were 0.0000, - 0.0040, 0.0140 and 0.0465 over the same time horizons. Point estimate incremental cost-effectiveness ratios (ICERs) suggested that the intervention was not cost-effective although the ratio improved over time: the ICER over 10 years was £82,250, falling to £37,500 over 30 years. The ICER fell below £30 000 only when the intervention cost was below £631 per patient: we estimated the cost at £981.
  
  
  CONCLUSIONS
  Given conventional thresholds of cost-effectiveness, the intensive treatment delivered in ADDITION was not cost-effective compared with routine care for individuals with screen-detected diabetes in the UK. The intervention may be cost-effective if it can be delivered at reduced cost.
authors: MRC Epidemiology Unit, University of Cambridge, Norwich, UK.
authors: L
authors: L
authors: Tao
authors: Cambridge Centre for Health Services Research, University of Cambridge, Norwich, UK.|Health Economics Group, University of East Anglia, Norwich, UK.
authors: E C F
authors: EC
authors: Wilson
authors: MRC Epidemiology Unit, University of Cambridge, Norwich, UK.
authors: N J
authors: NJ
authors: Wareham
authors: Department of Public Health, Section of General Practice, University of Aarhus, Denmark.
authors: A
authors: A
authors: Sandbaek
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
authors: G E H M
authors: GE
authors: Rutten
authors: Department of Public Health, Section of General Practice, University of Aarhus, Denmark.
authors: T
authors: T
authors: Lauritzen
authors: Diabetes Research Centre, University of Leicester, UK.
authors: K
authors: K
authors: Khunti
authors: Diabetes Research Centre, University of Leicester, UK.
authors: M J
authors: MJ
authors: Davies
authors: Department of Public Health, Section of General Practice, University of Aarhus, Denmark.|Holbaek Hospital, Denmark.
authors: K
authors: K
authors: Borch-Johnsen
authors: MRC Epidemiology Unit, University of Cambridge, Norwich, UK.
authors: S J
authors: SJ
authors: Griffin
authors: MRC Epidemiology Unit, University of Cambridge, Norwich, UK.
authors: R K
authors: RK
authors: Simmons
mesh_terms: D000368:Aged; D016000:Cluster Analysis; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010353:Patient Education as Topic / Q000191:economics; D018802:Patient-Centered Care / Q000191:economics; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology