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

• Published in: Diabetic medicine 2015-07, Vol.32 (7), p.907-919
• Main Authors: Tao, L., Wilson, E. C. F., Wareham, N. J., Sandbæk, A., Rutten, G. E. H. M., Lauritzen, T., Khunti, K., Davies, M. J., Borch-Johnsen, K., Griffin, S. J., Simmons, R. K.
• Format: Article
• Language: English
• Subjects: Aged; Cluster Analysis; Cohort Studies; Combined Modality Therapy - economics; Cost-Benefit Analysis; Diabetes; Diabetes Complications - economics; Diabetes Complications - epidemiology; Diabetes Complications - prevention & control; Diabetes Complications - therapy; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - economics; Diabetes Mellitus, Type 2 - therapy; Female; Health Care Costs; Humans; Incidence; Male; Mass Screening; Middle Aged; Patient Education as Topic - economics; Patient-Centered Care - economics; Quality-Adjusted Life Years; Risk Factors; Time Factors; United Kingdom - epidemiology
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12711

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. What's new? Existing evidence suggests that intensive multifactorial treatment of individuals with established diabetes reduces the risk of cardiovascular events by 50% and is cost‐effective relative to other preventive interventions. Less is known about the cost‐effectiveness of treatment earlier in the disease trajectory. Under conventional thresholds of cost‐effectiveness, interventions to promote intensive multifactorial treatment were not cost‐effective compared with routine care for individuals with screen‐detected diabetes in the UK.