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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.


Type

Article

Change log

Authors

Tao, L 
Wilson, ECF 
Wareham, NJ 
Sandbaek, A 
Rutten, GEHM 

Abstract

AIMS: 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. CONCLUSION: 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.

Description

Keywords

Aged, Cluster Analysis, Cohort Studies, Combined Modality Therapy, Cost-Benefit Analysis, Diabetes Complications, Diabetes Mellitus, Type 2, Female, Health Care Costs, Humans, Incidence, Male, Mass Screening, Middle Aged, Patient Education as Topic, Patient-Centered Care, Quality-Adjusted Life Years, Risk Factors, Time Factors, United Kingdom

Journal Title

Diabet Med

Conference Name

Journal ISSN

0742-3071
1464-5491

Volume Title

32

Publisher

Blackwell Publishing Ltd
Sponsorship
Medical Research Council (G0001164)
Medical Research Council (MC_UU_12015/1)
Medical Research Council (MC_UU_12015/4)
NIHR Central Commissioning Facility (NIHRDH-RP-PG-0606-1259)
Wellcome Trust (061895/Z/00/Z)
Medical Research Council (MC_U106179471)
Medical Research Council (MC_U106179474)
NETSCC (None)
NIHR Evaluation Trials and Studies Coordinating Centre (08/116/300)
ADDITION-Cambridge was supported by the Wellcome Trust (grant reference no: G061895); the Medical Research Council (grant reference no: G0001164); the National Institute for Health Research (NIHR) Health Technology Assessment Programme (grant reference no: 08⁄116⁄300); National Health Service R&D support funding (including the Primary Care Research and Diabetes Research Networks); and the National Institute for Health Research. SJG received support from the Department of Health NIHR Programme Grant funding scheme (RP-PG-0606-1259). The views expressed in this publication are those of the authors and not necessarily those of the UK Department of Health. Bio-Rad provided equipment for HbA1c testing during the screening phase. ADDITION-Leicester was supported by the Department of Health and ad hoc Support Sciences; the NIHR Health Technology Assessment Programme (grant reference no: 08⁄116⁄300); National Health Service R&D support funding (including the Primary Care Research and Diabetes Research Network, and LNR CLAHRC); and the National Institute for Health Research. MJD and KK receive support from the Department of Health NIHR Programme Grant funding scheme (RP-PG-0606-1272), the NIHR Collaboration for Leadership in Applied Health Research & Care (CLAHRC) and NIHR Leicester Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Centre.