The WISDOM self-management intervention: A cost-effectiveness analysis to support the transformation of type 2 diabetes care in England.

Abstract

ObjectivesTo assess the cost‐effectiveness of the WISDOM self‐management intervention for type 2 diabetes compared with care as usual.DesignWe performed a difference‐in‐differences analysis to estimate differences in risk factors for diabetes complications between people in the WISDOM group (n = 25, 276) and a control group (n = 15, 272) using GP records. A decision analytic model was then used to extrapolate differences in risk factors into costs and outcomes in the long term.SettingParticipating GP practices in West Hampshire and Southampton, UK.ParticipantsAll people diagnosed with type 2 diabetes between January 1990 and March 2020 (n = 40,548).OutcomesDiabetes‐related complications, quality‐adjusted life years (QALYs) and costs to the English National Health Service at 5 years and lifetime.InterventionsThe WISDOM intervention included risk stratification, self‐management education programme to professionals and people with type 2 diabetes, and monitoring of key treatment targets.ResultsWISDOM was associated with less atrial fibrillation [p = 0.001], albuminuria [p = 0.002] and blood pressure [p = 0.098]. Among all people in the intervention group, WISDOM led to 51 [95%CI: 25; 76] QALYs gained and saved £278,036 [95%CI: −631,900; 176,392] in the first 5 years after its implementation compared with care as usual. During those people' lifetime, WISDOM led to 253 [95%CI: 75; 404] QALYs gained and cost saving of £126,380 [95%CI: −1,466,008; 1,339,628]. The gains in QALYs were a result of reduced diabetes‐related complications through improved management of the associated risk factors.ConclusionsThe WISDOM risk‐stratification and education intervention for type 2 diabetes appear to be cost‐effective compared to usual care by reducing diabetes complications.