Cost-effectiveness of structured education in children with type-1 Diabetes Mellitus

Research output: Contribution to journalArticle

Authors

  • Alan Brennan
  • Richard Jacques
  • Daniel Pollard
  • Katherine Stevens
  • Jennifer Freeman
  • Jerry Wales
  • Katherine Price

Colleges, School and Institutes

External organisations

  • SHEFFIELD UNIVERSITY
  • Lady Cilento Children's Hospital
  • Sheffield Children's NHS Foundation Trust
  • University of Leeds

Abstract

Objectives
Kids in Control OF Food (KICk-OFF) is a 5-day structured education programme for 11-16 year olds with Type-1 diabetes mellitus (T1DM) who are using multiple daily insulin injections. This study evaluates the costeffectiveness of the KICk-OFF education programme compared to the usual care using data from the KICk-OFF trial.
Methods
The short-term within-trial analysis covers the two-year post-intervention period. Data on glycated haemoglobin (HbA1c), severe hypoglycaemia and diabetic ketoacidosis (DKA) were collected over a two-year follow-up period. Sub-group analyses have been defined on the basis of baseline HbA1c being below 7.5% (58.5 mmol/mol) (low group), between 7.5% and 9.5% (80.3 mmol/mol) (medium group), and over 9.5% (high group). The long-term cost-effectiveness evaluation has been conducted by using The Sheffield Type 1
Diabetes Policy Model, which is a patient-level simulation model on T1DM. It includes long-term microvascular (retinopathy, neuropathy and nephropathy) and macrovascular (myocardial infarction, stroke, revascularization and angina) diabetes-related complications and acute adverse events (severe hypoglycaemia
and diabetic ketoacidosis).
Results
The most favourable within-trial scenario for the KICk-OFF arm led to an ICER of £23,688 (base year 2009) with a cost-effectiveness probability of 41.3%. Simulating the long-term complications using the full cohort data, the mean ICER for the base case was £28,813 (base year 2011) and the probability of the KICk-OFF intervention being cost-effective at £20,000/QALY threshold was 42.6%, with considerable variation due to treatment effect duration. For the high HbA1c sub-group, the KICk-OFF arm was ‘dominant’ (meaning it provided better health gains at lower costs than usual care) over the usual care arm in each scenario considered.
Conclusions
For the whole study population, the cost-effectiveness of KICk-OFF depends on the assumption for treatment effect duration. For the high baseline HbA1c sub-group, KICk-OFF arm was estimated to be dominant over the usual care arm regardless of the assumption on the treatment effect duration.

Details

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalInternational Journal of Technology Assessment in Health Care
Publication statusPublished - 10 Oct 2016

Keywords

  • Cost-effectiveness analysis, Paediatrics, Structured education programme, Type 1 diabetes mellitus

ASJC Scopus subject areas