Delivering the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cost effectiveness analysis
BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4093 (Published 20 August 2010) Cite this as: BMJ 2010;341:c4093
- M Gillett, research fellow1,
- H M Dallosso, senior research associate2,
- S Dixon, reader in health economics1,
- A Brennan, professor of health economics and decision science1,
- M E Carey, national director2,
- M J Campbell, professor of medical statistics1,
- S Heller, professor of clinical medicine3,
- K Khunti, professor of diabetes medicine4,
- T C Skinner, associate professor5,
- M J Davies, professor of diabetes medicine6
- 1School of Health and Related Research (ScHARR), University of Sheffield, Sheffield
- 2DESMOND Project Office, University Hospitals of Leicester NHS Trust, Leicester
- 3Academic Unit of Diabetes, Endocrinology and Metabolism, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield
- 4Department of Health Sciences, University of Leicester, Leicester
- 5Combined Universities Centre for Rural Health, Geraldton, Australia
- 6Department of Cardiovascular Medicine, University of Leicester, Leicester Royal Infirmary, Leicester
- Correspondence to: M Gillett m.gillett{at}sheffield.ac.uk
- Accepted 20 May 2010
Abstract
Objectives To assess the long term clinical and cost effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) intervention compared with usual care in people with newly diagnosed type 2 diabetes.
Design We undertook a cost-utility analysis that used data from a 12 month, multicentre, cluster randomised controlled trial and, using the Sheffield type 2 diabetes model, modelled long term outcomes in terms of use of therapies, incidence of complications, mortality, and associated effect on costs and health related quality of life. A further cost-utility analysis was also conducted using current “real world” costs of delivering the intervention estimated for a hypothetical primary care trust.
Setting Primary care trusts in the United Kingdom.
Participants Patients with newly diagnosed type 2 diabetes.
Intervention A six hour structured group education programme delivered in the community by two professional healthcare educators.
Main outcome measures Incremental costs and quality adjusted life years (QALYs) gained.
Results On the basis of the data in the trial, the estimated mean incremental lifetime cost per person receiving the DESMOND intervention is £209 (95% confidence interval −£704 to £1137; €251, −€844 to €1363; $326, −$1098 to $1773), the incremental gain in QALYs per person is 0.0392 (−0.0813 to 0.1786), and the mean incremental cost per QALY is £5387. Using “real world” intervention costs, the lifetime incremental cost of the DESMOND intervention is £82 (−£831 to £1010) and the mean incremental cost per QALY gained is £2092. A probabilistic sensitivity analysis indicated that the likelihood that the DESMOND programme is cost effective at a threshold of £20 000 per QALY is 66% using trial based intervention costs and 70% using “real world” costs. Results from a one way sensitivity analysis suggest that the DESMOND intervention is cost effective even under more modest assumptions that include the effects of the intervention being lost after one year.
Conclusion Our results suggest that the DESMOND intervention is likely to be cost effective compared with usual care, especially with respect to the real world cost of the intervention to primary care trusts, with reductions in weight and smoking being the main benefits delivered.
Footnotes
Contributors: MG carried out the statistical analysis with advice and assistance from MJC, P Fitzgerald, and T Young. MG carried out the economic analysis with advice from SD and AB. HMD, MEC, SH, KK, and MJD assisted with the costing of the intervention. MG wrote the paper with assistance from HMD, SD, AB, MEC, MJC, SH, KK, TCS, and MJD. TCS, SH, MEC, KK, and MJD are the principal investigators of the DESMOND study. All authors had full access to all of the data in the study (including statistical reports and tables) and can take responsibility for the integrity of the data and the accuracy of the data analysis. MG is the guarantor.
Funding: The study was funded by a grant from Diabetes UK secured by the University Hospitals of Leicester NHS Trust. The analysis was independently designed and undertaken by the University of Sheffield School of Health and Related Research and collaborators. Researchers worked independently from the funders. Similarly the writing of the report and the decision to submit the article for publication was entirely independent of the funder. The study funder had no input into the study design or analysis, nor the interpretation of data.
Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any company for the submitted work; no financial relationships with any companies that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: The study was approved by the Huntingdon local research ethics committee.
Data sharing: No data from the original DESMOND trial is currently available for sharing at this moment in time.
- Accepted 20 May 2010
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