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

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 t...

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Veröffentlicht in:Diabetic medicine 2019-08, Vol.36 (8), p.1003-1012
Hauptverfasser: Xin, Y., Davies, A., McCombie, L., Briggs, A., Messow, C.‐M., Grieve, E., Leslie, W. S., Taylor, R., Lean, M. E. J.
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container_end_page 1012
container_issue 8
container_start_page 1003
container_title Diabetic medicine
container_volume 36
creator Xin, Y.
Davies, A.
McCombie, L.
Briggs, A.
Messow, C.‐M.
Grieve, E.
Leslie, W. S.
Taylor, R.
Lean, M. E. J.
description 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) What's new? Diabetes and its complications account for about 10% of healthcare budgets worldwide. The Counterweight‐Plus weight management programme in DiRECT achieved 46% remissions of Type 2 diabetes and improved cardiovascular risk factors at 1 year. One‐year incremental cost for the intervention group was estimated at £982 (95%CI £732, £1,258) per participant compared to the control arm. Providing the DiRECT/Counterweight‐Plus intervention in primary care incurs a cost (£2359 per 1‐year diabetes remission) below the average annual direct cost of managing a person with Type 2 diabetes (including its complications), and has the potential for long‐term cost‐effectiveness. Providing that a reasonable proportion of remissions can
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S. ; Taylor, R. ; Lean, M. E. J.</creator><creatorcontrib>Xin, Y. ; Davies, A. ; McCombie, L. ; Briggs, A. ; Messow, C.‐M. ; Grieve, E. ; Leslie, W. S. ; Taylor, R. ; Lean, M. E. J.</creatorcontrib><description>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) What's new? Diabetes and its complications account for about 10% of healthcare budgets worldwide. The Counterweight‐Plus weight management programme in DiRECT achieved 46% remissions of Type 2 diabetes and improved cardiovascular risk factors at 1 year. One‐year incremental cost for the intervention group was estimated at £982 (95%CI £732, £1,258) per participant compared to the control arm. Providing the DiRECT/Counterweight‐Plus intervention in primary care incurs a cost (£2359 per 1‐year diabetes remission) below the average annual direct cost of managing a person with Type 2 diabetes (including its complications), and has the potential for long‐term cost‐effectiveness. Providing that a reasonable proportion of remissions can be maintained over time, with multiple medical gains expected, and immediate social benefits, there is a case for shifting resources within diabetes care budgets to offer support for people with diabetes to attempt remission as early as possible after diagnosis.</description><identifier>ISSN: 0742-3071</identifier><identifier>EISSN: 1464-5491</identifier><identifier>DOI: 10.1111/dme.13981</identifier><identifier>PMID: 31026353</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Antihypertensives ; Cost control ; Cost-Benefit Analysis ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - economics ; Diabetes Mellitus, Type 2 - therapy ; Diet - economics ; Evidence-based medicine ; Facilities and Services Utilization ; General Practice - economics ; General Practice - statistics &amp; numerical data ; Hospitalization - economics ; Hospitalization - statistics &amp; numerical data ; Humans ; Hypertension ; Hypoglycemic Agents - economics ; Hypoglycemic Agents - therapeutic use ; Nutrient deficiency ; Patient Acceptance of Health Care - statistics &amp; numerical data ; Primary Health Care - economics ; Remission ; State Medicine - economics ; Weight Reduction Programs - economics</subject><ispartof>Diabetic medicine, 2019-08, Vol.36 (8), p.1003-1012</ispartof><rights>2019 Diabetes UK</rights><rights>2019 Diabetes UK.</rights><rights>Diabetic Medicine © 2019 Diabetes UK</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3881-39d8ded705c4c6d6d63e546de88342ca3009c1ae8df6dfd3eb48275f9b07c9d23</citedby><cites>FETCH-LOGICAL-c3881-39d8ded705c4c6d6d63e546de88342ca3009c1ae8df6dfd3eb48275f9b07c9d23</cites><orcidid>0000-0001-5856-3103</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fdme.13981$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fdme.13981$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31026353$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Xin, Y.</creatorcontrib><creatorcontrib>Davies, A.</creatorcontrib><creatorcontrib>McCombie, L.</creatorcontrib><creatorcontrib>Briggs, A.</creatorcontrib><creatorcontrib>Messow, C.‐M.</creatorcontrib><creatorcontrib>Grieve, E.</creatorcontrib><creatorcontrib>Leslie, W. S.</creatorcontrib><creatorcontrib>Taylor, R.</creatorcontrib><creatorcontrib>Lean, M. E. J.</creatorcontrib><title>Type 2 diabetes remission: economic evaluation of the DiRECT/Counterweight‐Plus weight management programme within a primary care randomized controlled trial</title><title>Diabetic medicine</title><addtitle>Diabet Med</addtitle><description>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) What's new? Diabetes and its complications account for about 10% of healthcare budgets worldwide. The Counterweight‐Plus weight management programme in DiRECT achieved 46% remissions of Type 2 diabetes and improved cardiovascular risk factors at 1 year. One‐year incremental cost for the intervention group was estimated at £982 (95%CI £732, £1,258) per participant compared to the control arm. Providing the DiRECT/Counterweight‐Plus intervention in primary care incurs a cost (£2359 per 1‐year diabetes remission) below the average annual direct cost of managing a person with Type 2 diabetes (including its complications), and has the potential for long‐term cost‐effectiveness. Providing that a reasonable proportion of remissions can be maintained over time, with multiple medical gains expected, and immediate social benefits, there is a case for shifting resources within diabetes care budgets to offer support for people with diabetes to attempt remission as early as possible after diagnosis.</description><subject>Adult</subject><subject>Antihypertensives</subject><subject>Cost control</subject><subject>Cost-Benefit Analysis</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2 - economics</subject><subject>Diabetes Mellitus, Type 2 - therapy</subject><subject>Diet - economics</subject><subject>Evidence-based medicine</subject><subject>Facilities and Services Utilization</subject><subject>General Practice - economics</subject><subject>General Practice - statistics &amp; numerical data</subject><subject>Hospitalization - economics</subject><subject>Hospitalization - statistics &amp; numerical data</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypoglycemic Agents - economics</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Nutrient deficiency</subject><subject>Patient Acceptance of Health Care - statistics &amp; numerical data</subject><subject>Primary Health Care - economics</subject><subject>Remission</subject><subject>State Medicine - economics</subject><subject>Weight Reduction Programs - economics</subject><issn>0742-3071</issn><issn>1464-5491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kUuOEzEQhi0EYsLAggsgS2xg0RM_-uFmN8qEhzQIhMK65djViUd-DLabKKw4AjfgbpwEQwcWSNgLV5U-_VXlH6HHlFzQcpbawQXlvaB30ILWbV01dU_vogXpalZx0tEz9CClG0Io63l_H51xSljLG75A3zfHW8AMayO3kCHhCM6kZIJ_gUEFH5xRGD5LO8lcijiMOO8BX5kP69VmuQqTzxAPYHb7_OPrt_d2SnjOsJNe7sCBz_g2hl2UzgE-mLw3HstSMk7GI1YyAo7S69LoC2hcWuYYrC1hjkbah-jeKG2CR6f3HH18ud6sXlfX7169WV1eV4oLQSvea6FBd6RRtWp1uRyautUgBK-ZkpyQXlEJQo-tHjWHbS1Y14z9lnSq14yfo2ezbpn10wQpD-UbFFgrPYQpDYzRlvVEdLSgT_9Bb8IUfZmuUI0gLeUdKdTzmVIxpBRhHE4rD5QMv1wbimvDb9cK--SkOG0d6L_kH5sKsJyBg7Fw_L_ScPV2PUv-BJV4pOE</recordid><startdate>201908</startdate><enddate>201908</enddate><creator>Xin, Y.</creator><creator>Davies, A.</creator><creator>McCombie, L.</creator><creator>Briggs, A.</creator><creator>Messow, C.‐M.</creator><creator>Grieve, E.</creator><creator>Leslie, W. S.</creator><creator>Taylor, R.</creator><creator>Lean, M. E. J.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5856-3103</orcidid></search><sort><creationdate>201908</creationdate><title>Type 2 diabetes remission: economic evaluation of the DiRECT/Counterweight‐Plus weight management programme within a primary care randomized controlled trial</title><author>Xin, Y. ; Davies, A. ; McCombie, L. ; Briggs, A. ; Messow, C.‐M. ; Grieve, E. ; Leslie, W. S. ; Taylor, R. ; Lean, M. E. J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3881-39d8ded705c4c6d6d63e546de88342ca3009c1ae8df6dfd3eb48275f9b07c9d23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Antihypertensives</topic><topic>Cost control</topic><topic>Cost-Benefit Analysis</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetes Mellitus, Type 2 - economics</topic><topic>Diabetes Mellitus, Type 2 - therapy</topic><topic>Diet - economics</topic><topic>Evidence-based medicine</topic><topic>Facilities and Services Utilization</topic><topic>General Practice - economics</topic><topic>General Practice - statistics &amp; numerical data</topic><topic>Hospitalization - economics</topic><topic>Hospitalization - statistics &amp; numerical data</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypoglycemic Agents - economics</topic><topic>Hypoglycemic Agents - therapeutic use</topic><topic>Nutrient deficiency</topic><topic>Patient Acceptance of Health Care - statistics &amp; numerical data</topic><topic>Primary Health Care - economics</topic><topic>Remission</topic><topic>State Medicine - economics</topic><topic>Weight Reduction Programs - economics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Xin, Y.</creatorcontrib><creatorcontrib>Davies, A.</creatorcontrib><creatorcontrib>McCombie, L.</creatorcontrib><creatorcontrib>Briggs, A.</creatorcontrib><creatorcontrib>Messow, C.‐M.</creatorcontrib><creatorcontrib>Grieve, E.</creatorcontrib><creatorcontrib>Leslie, W. S.</creatorcontrib><creatorcontrib>Taylor, R.</creatorcontrib><creatorcontrib>Lean, M. E. J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetic medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Xin, Y.</au><au>Davies, A.</au><au>McCombie, L.</au><au>Briggs, A.</au><au>Messow, C.‐M.</au><au>Grieve, E.</au><au>Leslie, W. S.</au><au>Taylor, R.</au><au>Lean, M. E. J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Type 2 diabetes remission: economic evaluation of the DiRECT/Counterweight‐Plus weight management programme within a primary care randomized controlled trial</atitle><jtitle>Diabetic medicine</jtitle><addtitle>Diabet Med</addtitle><date>2019-08</date><risdate>2019</risdate><volume>36</volume><issue>8</issue><spage>1003</spage><epage>1012</epage><pages>1003-1012</pages><issn>0742-3071</issn><eissn>1464-5491</eissn><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) What's new? Diabetes and its complications account for about 10% of healthcare budgets worldwide. The Counterweight‐Plus weight management programme in DiRECT achieved 46% remissions of Type 2 diabetes and improved cardiovascular risk factors at 1 year. One‐year incremental cost for the intervention group was estimated at £982 (95%CI £732, £1,258) per participant compared to the control arm. Providing the DiRECT/Counterweight‐Plus intervention in primary care incurs a cost (£2359 per 1‐year diabetes remission) below the average annual direct cost of managing a person with Type 2 diabetes (including its complications), and has the potential for long‐term cost‐effectiveness. Providing that a reasonable proportion of remissions can be maintained over time, with multiple medical gains expected, and immediate social benefits, there is a case for shifting resources within diabetes care budgets to offer support for people with diabetes to attempt remission as early as possible after diagnosis.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31026353</pmid><doi>10.1111/dme.13981</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-5856-3103</orcidid><oa>free_for_read</oa></addata></record>
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source MEDLINE; Wiley Journals
subjects Adult
Antihypertensives
Cost control
Cost-Benefit Analysis
Diabetes
Diabetes mellitus
Diabetes mellitus (non-insulin dependent)
Diabetes Mellitus, Type 2 - economics
Diabetes Mellitus, Type 2 - therapy
Diet - economics
Evidence-based medicine
Facilities and Services Utilization
General Practice - economics
General Practice - statistics & numerical data
Hospitalization - economics
Hospitalization - statistics & numerical data
Humans
Hypertension
Hypoglycemic Agents - economics
Hypoglycemic Agents - therapeutic use
Nutrient deficiency
Patient Acceptance of Health Care - statistics & numerical data
Primary Health Care - economics
Remission
State Medicine - economics
Weight Reduction Programs - economics
title Type 2 diabetes remission: economic evaluation of the DiRECT/Counterweight‐Plus weight management programme within a primary care randomized controlled trial
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