A model based cost-utility analysis of Embedding referral to structured self-management education into standard practice (Embedding) compared to usual care for people with type 2 diabetes diagnosis in the last 12 months in England
Objectives To conduct a cost-utility analysis of an implementation package that has been developed aiming to embed the referral of people with type 2 diabetes mellitus (T2DM) to structured self-management education (SSME) from primary care into routine practice compared with usual care.Design Model-...
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BMJ Publishing Group
2025-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/2/e093327.full |
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| author | Melanie J Davies Alan Brennan Danielle H Bodicoat Daniel John Pollard Anju Keetharuth Michelle Hadjiconstantinou Agnieszka Glab Joesph P Mensa Alison Northern |
| author_facet | Melanie J Davies Alan Brennan Danielle H Bodicoat Daniel John Pollard Anju Keetharuth Michelle Hadjiconstantinou Agnieszka Glab Joesph P Mensa Alison Northern |
| author_sort | Melanie J Davies |
| collection | DOAJ |
| description | Objectives To conduct a cost-utility analysis of an implementation package that has been developed aiming to embed the referral of people with type 2 diabetes mellitus (T2DM) to structured self-management education (SSME) from primary care into routine practice compared with usual care.Design Model-based cost-effectiveness analysis using the School for Public Health Research type 2 diabetes treatment model. With costs and effectiveness parameters coming from analyses of data from a cluster randomised control trial.Setting English National Health Service.Participants People with T2DM from 64 GP practices in England.Interventions Embedding SSME implementation package Usual care.Primary and secondary outcome measures The primary outcome measure was the incremental cost-effectiveness ratio. Secondary outcome measures included the probability of Embedding implementation package being cost-effective and value of information.Results The estimated cost of the intervention was £40 316 across the study sites, which equates to £0.521 per patient across all practices. For the base case, the estimated mean discounted incremental lifetime cost of the intervention per patient is £48.19. This is associated with a mean per patient incremental quality-adjusted life-year (QALY) estimate of 0.006, producing an incremental cost-effectiveness ratio of £8311 per QALY gained. This has a 73.1% probability of the intervention being cost-effective at a funding threshold of £20 000 per QALY gained. Scenario analyses indicate that alternative parameterisations can lead to this finding being overturned.Conclusions The effectiveness of the Embedding packages was hampered by the COVID-19 pandemic. However, our base case analysis shows that Embedding could be cost-effective for this patient population, but this was subject to significant structural uncertainty. This suggests that while implementation initiatives can be highly cost-effective in this population, more robust evidence or further incentivisation will be required before widespread adoption can be recommended.Trial registration number ISRCTN23474120, registered 05/04/2018. |
| format | Article |
| id | doaj-art-1ee09ec6570744efb0d924752d89522a |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-1ee09ec6570744efb0d924752d89522a2025-02-12T05:40:13ZengBMJ Publishing GroupBMJ Open2044-60552025-02-0115210.1136/bmjopen-2024-093327A model based cost-utility analysis of Embedding referral to structured self-management education into standard practice (Embedding) compared to usual care for people with type 2 diabetes diagnosis in the last 12 months in EnglandMelanie J Davies0Alan Brennan1Danielle H Bodicoat2Daniel John Pollard3Anju Keetharuth4Michelle Hadjiconstantinou5Agnieszka Glab6Joesph P Mensa7Alison Northern83 Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK1 Sheffield Centre for Health And Related Research (SCHARR), School of Medicine and Population Health, The University of Sheffield, Sheffield, UK2 Independent Researcher, Leicester, UK1 Sheffield Centre for Health And Related Research (SCHARR), School of Medicine and Population Health, The University of Sheffield, Sheffield, UK1 Sheffield Centre for Health And Related Research (SCHARR), School of Medicine and Population Health, The University of Sheffield, Sheffield, UK3 Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK3 Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK1 Sheffield Centre for Health And Related Research (SCHARR), School of Medicine and Population Health, The University of Sheffield, Sheffield, UK3 Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UKObjectives To conduct a cost-utility analysis of an implementation package that has been developed aiming to embed the referral of people with type 2 diabetes mellitus (T2DM) to structured self-management education (SSME) from primary care into routine practice compared with usual care.Design Model-based cost-effectiveness analysis using the School for Public Health Research type 2 diabetes treatment model. With costs and effectiveness parameters coming from analyses of data from a cluster randomised control trial.Setting English National Health Service.Participants People with T2DM from 64 GP practices in England.Interventions Embedding SSME implementation package Usual care.Primary and secondary outcome measures The primary outcome measure was the incremental cost-effectiveness ratio. Secondary outcome measures included the probability of Embedding implementation package being cost-effective and value of information.Results The estimated cost of the intervention was £40 316 across the study sites, which equates to £0.521 per patient across all practices. For the base case, the estimated mean discounted incremental lifetime cost of the intervention per patient is £48.19. This is associated with a mean per patient incremental quality-adjusted life-year (QALY) estimate of 0.006, producing an incremental cost-effectiveness ratio of £8311 per QALY gained. This has a 73.1% probability of the intervention being cost-effective at a funding threshold of £20 000 per QALY gained. Scenario analyses indicate that alternative parameterisations can lead to this finding being overturned.Conclusions The effectiveness of the Embedding packages was hampered by the COVID-19 pandemic. However, our base case analysis shows that Embedding could be cost-effective for this patient population, but this was subject to significant structural uncertainty. This suggests that while implementation initiatives can be highly cost-effective in this population, more robust evidence or further incentivisation will be required before widespread adoption can be recommended.Trial registration number ISRCTN23474120, registered 05/04/2018.https://bmjopen.bmj.com/content/15/2/e093327.full |
| spellingShingle | Melanie J Davies Alan Brennan Danielle H Bodicoat Daniel John Pollard Anju Keetharuth Michelle Hadjiconstantinou Agnieszka Glab Joesph P Mensa Alison Northern A model based cost-utility analysis of Embedding referral to structured self-management education into standard practice (Embedding) compared to usual care for people with type 2 diabetes diagnosis in the last 12 months in England BMJ Open |
| title | A model based cost-utility analysis of Embedding referral to structured self-management education into standard practice (Embedding) compared to usual care for people with type 2 diabetes diagnosis in the last 12 months in England |
| title_full | A model based cost-utility analysis of Embedding referral to structured self-management education into standard practice (Embedding) compared to usual care for people with type 2 diabetes diagnosis in the last 12 months in England |
| title_fullStr | A model based cost-utility analysis of Embedding referral to structured self-management education into standard practice (Embedding) compared to usual care for people with type 2 diabetes diagnosis in the last 12 months in England |
| title_full_unstemmed | A model based cost-utility analysis of Embedding referral to structured self-management education into standard practice (Embedding) compared to usual care for people with type 2 diabetes diagnosis in the last 12 months in England |
| title_short | A model based cost-utility analysis of Embedding referral to structured self-management education into standard practice (Embedding) compared to usual care for people with type 2 diabetes diagnosis in the last 12 months in England |
| title_sort | model based cost utility analysis of embedding referral to structured self management education into standard practice embedding compared to usual care for people with type 2 diabetes diagnosis in the last 12 months in england |
| url | https://bmjopen.bmj.com/content/15/2/e093327.full |
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