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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

Citation

Gillett, M and Dallosso, HM and Dixon, S and Brennan, A and Carey, ME and Campbell, MJ and Heller, S and Khunti, K and Skinner, TC and Davies, MJ, 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: (British Medical Journal), 341, (c4093) ISSN 0959-535X (2010) [Refereed Article]


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Copyright Statement

Copyright 2010 BMJ Publishing

DOI: doi:10.1136/bmj.c4093

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.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Clinical Sciences
Research Field:Endocrinology
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Diabetes
Author:Skinner, TC (Professor Timothy Skinner)
ID Code:74104
Year Published:2010
Web of Science® Times Cited:71
Deposited By:Research Division
Deposited On:2011-11-14
Last Modified:2014-08-26
Downloads:0

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