title: Cost-effectiveness of a pragmatic structured education intervention for the prevention of type 2 diabetes: economic evaluation of data from the Let's Prevent Diabetes cluster-randomised controlled trial.
abstract: Prevention of type 2 diabetes mellitus (TD2M) is a priority for healthcare systems. We estimated the cost-effectiveness compared with standard care of a structured education programme (Let's Prevent) targeting lifestyle and behaviour change to prevent progression to T2DM in people with prediabetes.
  
  
  
  Cost-effectiveness analysis alongside randomised controlled trial.
  
  
  
  44 general practices in Leicestershire, England.
  
  
  
  880 participants with prediabetes randomised to receive either standard care or a 6-hour group structured education programme with follow-up sessions in a primary care setting.
  
  
  
  Incremental cost utility from the UK National Health Service (NHS) perspective. Quality of life and resource use measured from baseline and during the 36 months follow-up using the EuroQoL EQ-5D and 15D instruments and an economic questionnaire. Outcomes measured using quality-adjusted life years (QALYs) and healthcare costs calculated in 2012-2013 prices.
  
  
  
  After accounting for clustering and missing data, the intervention group was found to have a net gain of 0.046 (95% CI -0.0171 to 0.109) QALYs over 3 years, adjusted for baseline utility, at an additional cost of £168 (95% CI -395 to 732) per patient compared with the standard care group. The incremental cost-effectiveness ratio is £3643/QALY with an 86% probability of being cost-effective at a willingness to pay threshold of £20 000/QALY.
  
  
  
  The education programme had higher costs and higher quality of life compared with the standard care group. The Let's Prevent programme is very likely to be cost-effective at a willingness to pay threshold of £20 000/QALY gained.
  
  
  
  ISRCTN80605705.
authors.affiliation: Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.
authors.forename: J
authors.identifier: 0000-0001-7870-6730
authors.initials: J
authors.lastname: Leal
authors.affiliation: Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.
authors.forename: D
authors.initials: D
authors.lastname: Ahrabian
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester, UK.|Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Davies
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: L J
authors.identifier: 0000-0003-0239-7278
authors.initials: LJ
authors.lastname: Gray
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester, UK.
authors.forename: K
authors.initials: K
authors.lastname: Khunti
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester, UK.|Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK.
authors.forename: T
authors.initials: T
authors.lastname: Yates
authors.affiliation: Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Gray
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000517:prevention & control; D005260:Female; D005102:Health Expenditures; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D000070497:Healthy Lifestyle; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D008297:Male; D010353:Patient Education as Topic; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
chemical_list: D007004:Hypoglycemic Agents
keywords: DIABETES & ENDOCRINOLOGY; HEALTH ECONOMICS; PREVENTIVE MEDICINE; PRIMARY CARE