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Cost effectiveness of group follow-up after structured education for type 1 diabetes: a cluster randomised controlled trial.
Gillespie, Paddy O'Shea, Eamon O Hara, Mary Clare Dinneen, Sean F
Gillespie, Paddy
O'Shea, Eamon
O Hara, Mary Clare
Dinneen, Sean F
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Date
2014-06-14
Date Submitted
Keywords
DIABETES MELLITUS
COST EFFECTIVENESS
COST EFFECTIVENESS
Other Subjects
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Start Date
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Principal Investigators
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Abstract
This study examines the cost effectiveness of group follow-up after participation in the Dose Adjustment for Normal Eating (DAFNE) structured education programme for type 1 diabetes.
Economic evaluation conducted alongside a cluster randomised controlled trial involving 437 adults with type 1 diabetes in Ireland. Group follow-up involved two group education 'booster' sessions post-DAFNE. Individual follow-up involved two standard one-to-one hospital clinic visits. Incremental costs, quality-adjusted life years (QALYs) gained and cost effectiveness were estimated at 18 months. Uncertainty was explored using sensitivity analysis and by estimating cost effectiveness acceptability curves.
Group follow-up was associated with a mean reduction in QALYs gained of 0.04 per patient (P value, 0.052; 95% CI, -0.08 to 0.01, intra-class correlation (ICC), 0.033) and a mean reduction in total healthcare costs of [euro sign]772 (P value, 0.020; 95% CI, -1,415 to -128: ICC, 0.016) per patient. At alternative threshold values of [euro sign]5,000, [euro sign]15,000, [euro sign]25,000, [euro sign]35,000, and [euro sign]45,000, the probability of group follow-up being cost effective was estimated to be 1.000, 0.762, 0.204, 0.078, and 0.033 respectively.
The results do not support implementation of group follow-up as the sole means of follow-up post-DAFNE. Given the reported cost savings, future studies should explore the cost effectiveness of alternative models of group care for diabetes.Trial registration: Current Controlled Trials ISRCTN79759174 (assigned: 9 February 2007).
Economic evaluation conducted alongside a cluster randomised controlled trial involving 437 adults with type 1 diabetes in Ireland. Group follow-up involved two group education 'booster' sessions post-DAFNE. Individual follow-up involved two standard one-to-one hospital clinic visits. Incremental costs, quality-adjusted life years (QALYs) gained and cost effectiveness were estimated at 18 months. Uncertainty was explored using sensitivity analysis and by estimating cost effectiveness acceptability curves.
Group follow-up was associated with a mean reduction in QALYs gained of 0.04 per patient (P value, 0.052; 95% CI, -0.08 to 0.01, intra-class correlation (ICC), 0.033) and a mean reduction in total healthcare costs of [euro sign]772 (P value, 0.020; 95% CI, -1,415 to -128: ICC, 0.016) per patient. At alternative threshold values of [euro sign]5,000, [euro sign]15,000, [euro sign]25,000, [euro sign]35,000, and [euro sign]45,000, the probability of group follow-up being cost effective was estimated to be 1.000, 0.762, 0.204, 0.078, and 0.033 respectively.
The results do not support implementation of group follow-up as the sole means of follow-up post-DAFNE. Given the reported cost savings, future studies should explore the cost effectiveness of alternative models of group care for diabetes.Trial registration: Current Controlled Trials ISRCTN79759174 (assigned: 9 February 2007).
Language
en
ISSN
1745-6215
eISSN
ISBN
DOI
10.1186/1745-6215-15-227
PMID
24927851