title: COST-EFFECTIVENESS OF STRUCTURED EDUCATION IN CHILDREN WITH TYPE-1 DIABETES MELLITUS.
abstract: OBJECTIVE
  Kids in Control OF Food (KICk-OFF) is a 5-day structured education program for 11- to 16-year-olds with type 1 diabetes mellitus (T1DM) who are using multiple daily insulin injections. This study evaluates the cost-effectiveness of the KICk-OFF education program compared with the usual care using data from the KICk-OFF trial.
  
  
  METHODS
  The short-term within-trial analysis covers the 2-year postintervention period. Data on glycated hemoglobin (HbA1c), severe hypoglycemia, and diabetic ketoacidosis (DKA) were collected over a 2-year follow-up period. Sub-group analyses have been defined on the basis of baseline HbA1c being below 7.5 percent (58.5 mmol/mol) (low group), between 7.5 percent and 9.5 percent (80.3 mmol/mol) (medium group), and over 9.5 percent (high group). The long-term cost-effectiveness evaluation has been conducted by using The Sheffield Type 1 Diabetes Policy Model, which is a patient-level simulation model on T1DM. It includes long-term microvascular (retinopathy, neuropathy, and nephropathy) and macrovascular (myocardial infarction, stroke, revascularization, and angina) diabetes-related complications and acute adverse events (severe hypoglycemia and DKA).
  
  
  RESULTS
  The most favorable within-trial scenario for the KICk-OFF arm led to an incremental cost-effectiveness ratio (ICER) of £23,688 (base year 2009) with a cost-effectiveness probability of 41.3 percent. Simulating the long-term complications using the full cohort data, the mean ICER for the base case was £28,813 (base year 2011) and the probability of the KICk-OFF intervention being cost-effective at £20,000/QALY threshold was 42.6 percent, with considerable variation due to treatment effect duration. For the high HbA1c sub-group, the KICk-OFF arm was "dominant" (meaning it provided better health gains at lower costs than usual care) over the usual care arm in each scenario considered.
  
  
  CONCLUSIONS
  For the whole study population, the cost-effectiveness of KICk-OFF depends on the assumption for treatment effect duration. For the high baseline HbA1c sub-group, KICk-OFF arm was estimated to be dominant over the usual care arm regardless of the assumption on the treatment effect duration.
authors.affiliation: Health Economics Unit,University of Birminghamh.basarir@bham.ac.uk.
authors.forename: Hasan
authors.initials: H
authors.lastname: Basarir
authors.affiliation: School of Health and Related Research,University of Sheffield.
authors.forename: Alan
authors.initials: A
authors.lastname: Brennan
authors.affiliation: School of Health and Related Research,University of Sheffield.
authors.forename: Richard
authors.initials: R
authors.lastname: Jacques
authors.affiliation: School of Health and Related Research,University of Sheffield.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pollard
authors.affiliation: School of Health and Related Research,University of Sheffield.
authors.forename: Katherine
authors.initials: K
authors.lastname: Stevens
authors.affiliation: University of Leeds,Leeds.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Freeman
authors.affiliation: Lady Cilento Children's Hospital.
authors.forename: Jerry
authors.initials: J
authors.lastname: Wales
authors.affiliation: Sheffield Children's NHS Foundation Trust.
authors.forename: Katherine
authors.initials: K
authors.lastname: Price
mesh_terms: D000293:Adolescent; D002648:Child; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000191:economics / Q000517:prevention & control*; D003922:Diabetes Mellitus, Type 1 / Q000191:economics / Q000628:therapy*; D016883:Diabetic Ketoacidosis / Q000517:prevention & control; D004032:Diet; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D017059:Models, Econometric; D010353:Patient Education as Topic / Q000191:economics / Q000458:organization & administration*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Cost-effectiveness analysis; Paediatrics; Structured education programme; Type 1 diabetes mellitus