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ToolsLaxy, Michael, Wilson, Edward C. F., Boothby, Clare E. and Griffin, Simon J. (2017) Incremental costs and cost effectiveness of intensive treatment in individuals with type 2 diabetes detected by screening in the ADDITION-UK trial:An update with empirical trial–based cost data. Value in Health, 20 (10). pp. 1288-1298. ISSN 1098-3015
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Abstract
Background: There is uncertainty about the cost effectiveness of early intensive treatment versus routine care in individuals with type 2 diabetes detected by screening. Objectives: To derive a trial-informed estimate of the incremental costs of intensive treatment as delivered in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care-Europe (ADDITION) trial and to revisit the long-term cost-effectiveness analysis from the perspective of the UK National Health Service. Methods: We analyzed the electronic primary care records of a subsample of the ADDITION-Cambridge trial cohort (n = 173). Unit costs of used primary care services were taken from the published literature. Incremental annual costs of intensive treatment versus routine care in years 1 to 5 after diagnosis were calculated using multilevel generalized linear models. We revisited the long-term cost-utility analyses for the ADDITION-UK trial cohort and reported results for ADDITION-Cambridge using the UK Prospective Diabetes Study Outcomes Model and the trial-informed cost estimates according to a previously developed evaluation framework. Results: Incremental annual costs of intensive treatment over years 1 to 5 averaged £29.10 (standard error = £33.00) for consultations with general practitioners and nurses and £54.60 (standard error = £28.50) for metabolic and cardioprotective medication. For ADDITION-UK, over the 10-, 20-, and 30-year time horizon, adjusted incremental quality-adjusted life-years (QALYs) were 0.014, 0.043, and 0.048, and adjusted incremental costs were £1,021, £1,217, and £1,311, resulting in incremental cost-effectiveness ratios of £71,232/QALY, £28,444/QALY, and £27,549/QALY, respectively. Respective incremental cost-effectiveness ratios for ADDITION-Cambridge were slightly higher. Conclusions: The incremental costs of intensive treatment as delivered in the ADDITION-Cambridge trial were lower than expected. Given UK willingness-to-pay thresholds in patients with screen-detected diabetes, intensive treatment is of borderline cost effectiveness over a time horizon of 20 years and more.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | addition trial,cost effectiveness,intensive treatment,screen-detected diabetes,health policy,public health, environmental and occupational health,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2719 |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 12 Nov 2018 14:31 |
| Last Modified: | 20 Feb 2025 01:08 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/68854 |
| DOI: | 10.1016/j.jval.2017.05.018 |
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