Health economic evaluation of “A multidisciplinary psychosocial treatment approach for patients with diabetes (psy-PAD)”

Objective: Based on a RCT, we assessed the cost-effectiveness of psy-PAD compared to optimized usual care. Psy-PAD is a multidisciplinary psychodynamic treatment approach to improve poor glycaemic control in patients with diabetes and related psychosocial distress. As shown, the psy-PAD intervention can improve glycaemic control in the short-term. Method: The analysis was performed taking the perspective of a German payer. An incremental cost effectiveness ratio (costs per additional patient with 1% HbA1c decrease) was calculated at 6-month follow-up (t1). Uncertainty was presented by means of cost-effectiveness acceptability curves and sensitivity analyses. Mixed linear models adjusted for repeated measurement were fitted to adjust for missings in the per-protocol analysis. Results: Of N=213 screened patients N=178 were randomised. For the evaluation we only included patients who participated in the first follow-up examination at t1 (N=143); of these 69 patients were in the intervention group (62.3% female, mean age 49.4±11.6) and 74 in the control group (66.2* female, mean age 46.7±11.8). Psy-PAD showed a significant reduction of the HbA1c (%) at t1 (-0.49%. 95%-BCA Q (-0.86;-0.121) '" comparison to optimized usual care. This leads to a chance of greater than 99.3% for psy-PAD to be cost-effective considering a willingness to pay threshold of 5.000 EURO per 1% reduction of the HbA1c in the short term. Conclusion: So far. no threshold values have been defined for cost-effectivness when considering HbAlc. However, there is a high probability that psy-PAD can cost-effectively improve glycaemic control in the short-term, taking into account the individual willingness to pay.