The study assessed the cost-effectiveness of Healthy Living, an NHS online Diabetes Self-Management Education and Support service. Observational one-year reductions in HbA1c, systolic blood pressure and body mass index were entered into the UKPDS-OM2.1 patient-level model. The analysis took an NHS perspective over a lifetime horizon, discounted at 3.5%, compared with usual care. The model predicted 0.016 QALYs gained and a £4 reduction in lifetime healthcare costs per person. Intervention and medication costs of £7 and £212 per user gave £13,192 per QALY, below the £25,000 NICE threshold. Results were sensitive to assumptions about disease progression after the intervention, and effectiveness came from observational data.
Why it is interesting: A digital self-management service gives small risk factor changes that the model turns into a cost per QALY under the NICE threshold.
Abstract — the authors' own words, CC BY
Abstract
Aims
The National Health Service (NHS) offers
Healthy Living
, an online Diabetes Self‐Management Education and Support service, to help people Self Manage Type 2 Diabetes, with modest 1‐year reductions in HbA1c levels, systolic blood pressure and body mass index. We aim to assess the cost‐effectiveness of
Healthy Living
compared with usual care.
Methods
A patient‐level economic simulation model (UKPDS‐OM2.1) was used to conduct an economic analysis from the NHS perspective over a lifetime horizon, discounted at 3.5%. The model translated risk factor reductions to long‐term cost and quality‐adjusted life year (QALY) estimates. Additional analyses estimated intervention and medication cost consequences.
Results
The UKPDS‐OM2.1 predicted a modest improvement in health (0.016 QALYs) and a small reduction in lifetime healthcare costs (−£4 per person). Offsetting with intervention costs (£7 per user) and increased medication costs (£212 per user) yielded a net cost of £216 per user. The cost‐per‐QALY of £13,192 was below the lower NICE threshold (£25,000/QALY), indicating that the programme is cost‐effective. Sensitivity analyses largely demonstrated robustness, but the finding was sensitive to structural assumptions about disease progression post‐intervention with the inclusion of medication costs.
Conclusion
Healthy Living
appears to be a low‐cost, online intervention for self managing type 2 diabetes, generating modest health benefits that are likely to be considered cost‐effective use of NHS resources. While there is some uncertainty in the cost‐effectiveness and the modelling is based on effectiveness estimated from observational data, improvements in uptake and adherence has the potential to improve the value for money to the NHS.
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