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COST EFFECTIVENESS OF PEER SUPPORT FOR TYPE 2 DIABETES

Published online by Cambridge University Press:  23 January 2012

Paddy Gillespie
Affiliation:
National University of Ireland, Galway email: paddy.gillespie@nuigalway.ie
Eamon O'Shea
Affiliation:
National University of Ireland, Galway
Gillian Paul
Affiliation:
Trinity College Dublin
Tom O'Dowd
Affiliation:
Trinity College Dublin
Susan M. Smith
Affiliation:
Royal College of Surgeons Ireland

Abstract

Objectives: The aim of this study is to examine the cost-effectiveness of a group-based peer support intervention in general practice for patients with type 2 diabetes.

Methods: Incremental cost utility analysis combining within trial and beyond trial components to compare the lifetime costs and benefits of alternative strategies: Control: standardized diabetes care; Intervention: group-based peer support in addition to standardized diabetes care. Within trial analysis was based on a cluster randomized controlled trial of 395 patients with type 2 diabetes in the east of Ireland. Beyond trial analysis was conducted using the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model. Uncertainty was explored using a range of sensitivity analyses and cost-effectiveness acceptability curves were generated.

Results: Compared with the control strategy, the intervention was associated with an increase of 0.09 (95 percent confidence interval [CI], −0.05 to 0.25) in mean quality-adjusted life-years per patient and savings of €637.43 (95 percent CI, −2455.19 to 1125.45) in mean healthcare cost per patient and €623.39 (95 percent CI, −2507.98 to 1298.49) in mean total cost per patient respectively. The likelihood of the intervention being cost-effective was appreciably higher than 80 percent for a range of potential willingness-to-pay cost-effectiveness thresholds.

Conclusions: Our results suggest that while a group-based peer support intervention shows a trend toward improved risk factor management, we found no significant differences in final cost or effectiveness endpoints between intervention and control. The probabilistic results suggest that the intervention was more cost-effective, with probability values of higher than 80 percent across a range of potential cost-effectiveness threshold values.

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Copyright © Cambridge University Press 2012

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References

REFERENCES

1.American Diabetes Association. Economic costs of diabetes in the U.S. in 2007. Diabetes Care. 2008;31:569615.Google Scholar
2.Barry, M, Tilson, L. Recent developments in pricing and reimbursement of medicines in Ireland. Expert Rev Pharmacoecon Outcomes Res. 2009;7:605611.CrossRefGoogle Scholar
3.Briggs, A.A Bayesian approach to stochastic cost effectiveness analysis: An illustration and application to blood pressure control in type 2 diabetes. Int J Technol Assess Health Care. 2001;17:6982.CrossRefGoogle ScholarPubMed
4.Campbell, MK, Elbourne, DR, Altman, DG, et al. CONSORT statement: Extension to cluster randomised trials. BMJ. 2004;328:702708.CrossRefGoogle ScholarPubMed
5.Caro, JF, Fisher, EB. A solution might be within people with diabetes themselves. Fam Pract. 2010;27 (Suppl 1):i1i2.CrossRefGoogle ScholarPubMed
6.Brownson, CA, Hoerger, TJ, Fisher, EB, Kilpatrick, KE. Cost-effectiveness of diabetes self-management programs in community primary care settings. Diabetes Educ. 2009;35:761769.CrossRefGoogle ScholarPubMed
7.Central Bank of Ireland. Dublin. www.centralbank.ie (accessed January 11, 2010).Google Scholar
8.Central Statistics Office. Dublin. www.cso.ie (accessed January 11, 2010).Google Scholar
9.Clarke, PM, Gray, AM, Briggs, A, Stevens, RJ, Matthews, DR, Holman, RR. Cost-utility analyses of intensive blood glucose and tight blood pressure control in type 2 diabetes (UKPDS 72). Diabetologia. 2005;48:868877.CrossRefGoogle ScholarPubMed
10.Clarke, PM, Gray, AM, Briggs, A, et al. A model to estimate the lifetime health outcomes of patients with type2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68). Diabetologia. 2004;47:17471759.CrossRefGoogle Scholar
11.Clarke, P, Gray, A, Legood, R, et al. The impact of diabetes-related complications on healthcare costs: Results from the United Kingdom Prospective Diabetes Study (UKPDS Study No. 65). Diabet Med. 2003;20:442450.CrossRefGoogle ScholarPubMed
12.Drummond, MF, Sculpher, MJ, Torrance, GW, O'Brien, J, Stoddart, GL. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press; 2005.CrossRefGoogle Scholar
13.Glick, HA, Doshi, JA, Sonnad, SS, Polsky, D. Economic evaluation in clinical trials. Oxford: Oxford University Press; 2007.Google Scholar
14.Hardin, JW, Hilbe, JM. Generalised estimating equations. London: Chapman and Hall/CRC Press; 2003.Google Scholar
15.Johnston, K, Gray, A, Moher, M, Yudkin, P, Wright, L, Mant, D. Reporting the cost-effectiveness of interventions with nonsignificant effect differences: Example from the a trial of secondary prevention of heart disease. Int J Technol Assess Health Care. 2003;19:476489.CrossRefGoogle Scholar
16.Massi-Benedetti, M, The cost of diabetes type II in Europe: The CODE-2 study. Diabetologia. 2002;45:S1S4.CrossRefGoogle ScholarPubMed
17.Mount Hood 4 Modeling Group. Computer modeling of diabetes and its complications: A report on the fourth Mount Hood Challenge Meeting. Diabetes Care. 2007;30:16381646: http://care.diabetesjournals.org/cgi/reprint/30/6/1638 (accessed October 7, 2009).CrossRefGoogle Scholar
18.National Institute for Clinical Excellence. Guide to the methods of technology appraisal. London: NICE; Apr 2004. www.nice.org.uk/page.aspx?o=201974 (reference 0515).Google Scholar
19.Nolan, JJ, O'Halloran, D, McKenna, TJ, Firth, R, Redmond, S. The cost of treating type 2 diabetes (CODEIRE). Ir Med J. 2006;99:307310.Google ScholarPubMed
20.Paul, G, Smith, SM, Whitford, D, O'Shea, E, O'Kelly, F, O'Dowd, T. Peer support in type 2 diabetes: A randomised controlled trial in primary care with parallel economic and qualitative analyses: Pilot study and protocol. BMC Fam Pract. 2007;8:45.CrossRefGoogle ScholarPubMed
21.Smith, SM, Paul, G, Kelly, A, Whitford, DL, O'Shea E, O'Dowd, T. Peer support for type 2 diabetes: A cluster randomized controlled trial. BMJ. 2011;342:d715.CrossRefGoogle Scholar
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