Benchmarking the cost-effectiveness of interventions delaying diabetes: a simulation study based on NAVIGATOR data

Abstract

<b>Objective</b>: To estimate using the United Kingdom Prospective Diabetes Study Outcomes Model Version 2 (UKPDS-OM2) the impact of delaying type 2 diabetes onset on costs and quality-adjusted life expectancy using trial participants who developed diabetes in the NAVIGATOR study. <p><b>Research design and methods</b>: We simulated the impact of delaying diabetes onset by one to nine years, utilising data from the 3058 of 9306 NAVIGATOR trial participants who developed type 2 diabetes. Costs and utility weights associated with diabetes and diabetes-related complications were obtained for US and UK settings, with costs expressed in 2017 values. We estimated discounted lifetime costs and quality-adjusted life years (QALYs) with 95% confidence intervals.</p> <p><b>Results</b>: Gains in QALYs increased from 0.02 (95% CI: 0.01, 0.03; US setting) to 0.15 (95% CI: 0.11, 0.20; US setting) as the imposed time to diabetes onset was increased from one to nine years, respectively. Savings in complication costs increased from $1,388 (95%CI: $1,092, $1,669) for one-year delay to $8,437 (95% CI: $5603, $8630) for a delay of nine years. Interventions costing up to $567-$2,680 and £201-£947 per year would be cost-effective at $100,000 per QALY and £20,000 per QALY thresholds in the US and UK, respectively, as the modelled delay in diabetes onset was increased from one to nine years. </p> <p><b>Conclusions</b>: Simulating a hypothetical diabetes-delaying intervention provides guidance concerning the maximum cost and minimum delay in diabetes onset needed to be cost-effective. These results can inform the ongoing debate about diabetes prevention strategies and the design of future intervention studies. </p>