Type 2 diabetes remission: economic evaluation of the DiRECT/Counterweight‐Plus weight management programme within a primary care randomized controlled trial

Xin, Y. , Davies, A., McCombie, L., Briggs, A. , Messow, C.-M. , Grieve, E. , Leslie, W.S., Taylor, R. and Lean, M.E.J. (2019) Type 2 diabetes remission: economic evaluation of the DiRECT/Counterweight‐Plus weight management programme within a primary care randomized controlled trial. Diabetic Medicine, 36(8), pp. 1003-1012. (doi: 10.1111/dme.13981) (PMID:31026353)

Abstract

Aim: The Counterweight‐Plus weight management programme achieved 46% remission of Type 2 diabetes at 1 year in the DiRECT trial. We estimated the implementation costs of the Counterweight‐Plus programme and its 1‐year cost‐effectiveness in terms of diabetes remission, compared with usual care, from the UK National Health Service (NHS) perspective. Methods: Within‐trial total costs included programme set‐up and running costs (practitioner appointment visits, low‐energy formula diet sachets and training), oral anti‐diabetes and anti‐hypertensive medications, and healthcare contacts. Total costs were calculated for aggregated resource use for each participant and 95% confidence intervals (CI) were based on 1000 non‐parametric bootstrap iterations. Results: One‐year programme costs under trial conditions were estimated at £1137 per participant (95% CI £1071, £1205). The intervention led to a significant cost‐saving of £120 (95% CI £78, £163) for the oral anti‐diabetes drugs and £14 (95% CI £7.9, £22) for anti‐hypertensive medications compared with the control. Deducting the cost‐savings of all healthcare contacts from the intervention cost resulted an incremental cost of £982 (95% CI £732, £1258). Cost per 1 year of diabetes remission was £2359 (95% CI £1668, £3250). Conclusions: Remission of Type 2 diabetes within 1‐year can be achieved at a cost below the annual cost of diabetes (including complications). Providing a reasonable proportion of remissions can be maintained over time, with multiple medical gains expected, as well as immediate social benefits, there is a case for shifting resources within diabetes care budgets to offer support for people with Type 2 diabetes to attempt remission. (Clinical Trial Registry No.: ISRCTN03267836).

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Xin, Miss Yiqiao and Grieve, Dr Eleanor and Messow, Dr Martina and Lean, Professor Michael and Davies, Mr Andrew and Leslie, Dr Wilma and Briggs, Professor Andrew
• Authors: Xin, Y., Davies, A., McCombie, L., Briggs, A., Messow, C.-M., Grieve, E., Leslie, W.S., Taylor, R., and Lean, M.E.J.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Diabetic Medicine
• Publisher: Wiley
• ISSN: 0742-3071
• ISSN (Online): 1464-5491
• Published Online: 26 April 2019
• Copyright Holders: Copyright © 2019 Diabetes UK
• First Published: First published in Diabetic Medicine 36(8): 1003-1012
• Publisher Policy: Reproduced in accordance with the publisher copyright policy

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
61461	4	Reversal of T2DM to normal glucose tolerance using non-surgical weight management with low-energy liquid- diet and long-term maintenance, within routine NHS care: study extension	Michael Lean	Diabetes UK (DIABETUK)	13/0004691	MVLS MED -HUMAN NUTRITION
300792	0	Economic Evaluation of the Diabetes Remission Clinical Trial DiRECT	Michael Lean	Diabetes UK (DIABETUK)	17/0005695	Med - Human Nutrition