Table 6

 Economic evaluation of the DESMOND intervention compared with usual care (control) using trial based costs and “real world” costs

ControlDESMOND interventionDifference: intervention − control (95% CI)
Intervention costs up to month 12
Trial based intervention cost £203£203
“Real world” intervention cost £76£76
Other resource use (per within trial analysis) £244£260*£16 (−£24 to £56)
Remaining lifetime discounted costs
Therapy and monitoring £5286£5302£17
Complications£10 445£10 419−£26
Adverse events (for example, oedema, hypoglycaemic attacks) £105£104−£1
Subtotal: remaining lifetime costs£15 836£15 826−£10
Combined total lifetime costs
Trial based total costs£16 080£16 289£209 (−£704 to £1137)
“Real world” total costs £16 080£16 162£82 (−£831 to £1010)
QALY gain up to month 120.75300.7600†0.0070 (−0.0126 to 0.0491)
Discounted QALYs in remaining lifetime
Mean QALYs lived if not diabetic 13.919513.91950
QALYs lost because of reduced survival related to diabetes −4.2809−4.25260.0283‡
QALYs lost because of complications of diabetes−0.3835−0.38330.0002
Weight related change in QALYs−0.0447−0.04100.0037
Subtotal: QALYs in remaining lifetime9.21049.24260.0322
Combined total QALYs gained in lifetime9.963410.00260.0392 (−0.0813 to 0.1786)
Incremental cost per QALY gained
Trial based total costs£5387
“Real world” total costs£2092§

DESMOND, diabetes education and self management for ongoing and newly diagnosed; QALY, quality adjusted life year.

*Other resource use shown as actual cost in control arm plus £16 for the cluster adjusted difference between study arms.

†QALY gain up to month 12 shown as actual QALYs in control arm plus 0.0070 for the cluster adjusted difference between study arms.

‡Difference in QALYs lost because of reduced survival related to diabetes attributable mostly to the net effect of differences in smoking on other cause and cardiovascular mortality.

§See the cost effectiveness plane in figure 2[F2] for the distribution of cost effectiveness estimates.