DiRECT/Counterweight-Plus intervention could be cost-effective long-term
medwireNews: Type 2 diabetes remission can be achieved within 1 year at a cost below the average annual cost of diabetes management, even when including complications, shows an economic evaluation of the DiRECT/Counterweight-Plus weight management program.
“Providing a reasonable proportion of remissions can be maintained over time, with multiple medical gains expected, as well as immediate social benefits, there is a case for shifting resources within diabetes care budgets to offer support for people with Type 2 diabetes to attempt remission as early as possible after diagnosis,” Michael Lean (University of Glasgow, UK) and co-investigators remark.
As previously reported by medwireNews, 46% of 149 participants of the DiRECT trial who were randomly assigned to follow the Counterweight‐Plus weight management program achieved type 2 diabetes remission after 1 year. At 2 years, the remission rate was 36%.
In the current study, the researchers used the 1–year data to estimate the cost-effectiveness of the program compared with usual care, taking into account program set‐up and running costs (practitioner appointment visits, low‐energy formula diet sachets and training), healthcare contacts, and the costs of oral antidiabetic and antihypertensive medications.
They report in Diabetic Medicine that, under trial conditions, the program cost £ 1223 (US$ 1585, € 1410) per participant at 1 year.
Approximately one-third of the intervention cost (£ 447, $ 579, € 515) arose from the average 15.6 practitioner visits per patient observed over the first year, while 58% (£ 707, $ 916, € 815) was due to the cost of the mean 495 sachets issued to each participant. The cost of setting up the intervention accounted for the remaining 4%.
At the start of the intervention patients stopped all antidiabetic and antihypertensive medications, with later reintroduction where necessary, which was reflected in the fact that the intervention led to significant cost‐savings of £ 120 ($ 155, € 138) per participant in oral antidiabetic medication and £ 14 ($ 18, € 16) per participant in antihypertensive medication compared with usual care.
Overall, the mean cost of care per participant was £ 1913 ($ 2479, € 2205) in the intervention group and £ 846 ($ 1092, € 974) in the control group, resulting in a net intervention cost of £ 1067 ($ 1383, € 1230) per participant.
When this was combined with the incremental remission rate of 42%, Lean and team found that the incremental cost per diabetes remission over the first year was £ 2564 ($ 3322, € 2956).
However, the authors point out that “[i]ntervention delivery costs may be reduced when rolled out in routine practice,” because training costs “will be lower as each trained practitioner manages many more people,” and the cost of the formula diet sachets per participant may fall “if lower unit costs can be negotiated for large contracts.”
Nonetheless, Lean et al say that “[t]he delivery cost of the DiRECT/Counterweight-Plus programme compares favourably with other diabetes remission interventions,” such as the US Look AHEAD trial in type 2 diabetes, which cost more (£ 2213, $ 2865, € 2551 per participant, 2012 values) but resulted in less weight loss and a fourfold lower remission rate at 1 year (12%).
The team concludes that although this analysis is based on 1-year outcomes, “DiRECT is on-going, and further data will support future cost-effectiveness analyses incorporating long-term outcomes including quality-adjusted life-years.”
By Laura Cowen
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