The cost-effectiveness of providing DAFNE to subgroups of predicted responders 2012

Abstract

The Dose Adjustment for Normal Eating (DAFNE) course is a structured education programme for adult patients with Type 1 diabetes. DAFNE has been found to improve glycosylated haemoglobin (HbA1c) levels in UK Type 1 diabetes patients1 and a cost-effectiveness modelling analysis concluded that DAFNE was cost-effective from the NHS perspective2. This analysis assumed that HbA1c benefit experienced by patients receiving DAFNE was homogeneous, however it has been found that HbA1c response to DAFNE is highly variable between patients. Although some patients do experience significant HbA1c reductions after DAFNE, other patients experience a worsening of HbA1c1,3 and some find it difficult to maintain initial HbA1c improvements4. Targeting DAFNE to only those patients that are expected to benefit may improve the cost-effectiveness of the intervention. This study aims to explore statistical modelling methodologies to predict individual clinical responses to DAFNE from psychosocial characteristics and incorporate psychosocial predictors into an economic simulation model to investigate the cost-effectiveness of providing DAFNE to subgroups of predicted responders.