DESMOND interventie kosteneffectief voor Type 2 diabetes patiënten

Nieuws - 23 aug. 2010

Study results indicate that the diabetes education and self management for ongoing and newly diagnosed (DESMOND) intervention improves quality adjusted life years (QALYs) and is cost effective for individuals with newly diagnosed Type 2 diabetes.

Michael Gillett (University of Sheffield, UK) and colleagues used data from a 12-month randomized controlled trial comparing a 6-hour (over 12 weeks) structured group education program (DESMOND) with usual care in 824 patients with Type 2 diabetes, who had been referred within 4 weeks of diagnosis, to assess the cost effectiveness of the intervention.

Writing in the British Medical Journal, they report that the mean incremental lifetime cost per person who received DESMOND was £209 (US $326; €251). The estimated incremental gain in QALYs per person with the intervention was 0.0392, and the mean incremental cost per QALY gained £5387 (US $8373; €6592).

The researchers now believe the intervention could be delivered at lower cost than observed in the trial, as they now have a better appreciation of resource requirements and a more accurate idea of economies of scale through widespread delivery of the programme.

When they estimated "real world" costs for the intervention using this information,. they found that the "incremental lifetime cost per person would be £82 (US $127; €100), with a resulting mean incremental cost per QALY gained of £2092 (US $3252; €2560).

Using a threshold of £20,000 (US $31,086; €24,475) per QALY, the probability of DESMOND being cost effective using both trial-based and "real world" costs was calculated to be 66% and 70%, respectively.

Further analysis suggested that the DESMOND intervention would be cost effective even if the beneficial effects were less pronounced or were lost after 1 year.

"People attending DESMOND sessions are encouraged to decide on their own goals, which often include weight loss and smoking cessation. These outcomes were both significantly improved in the trial and were the most important drivers in the economic analysis," say Gillett et al.

"Our analysis indicates that the DESMOND program is likely to be a cost effective form of structured education that should be given in line with National Institute for Health and Clinical Excellence guidance," they conclude.

BMJ 2010;341:c4093

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