Abstract
Aims/hypothesisApproximately 10% of total healthcare budgets worldwide are spent on treating diabetes and its complications, and budgets are increasing globally because of ageing populations and more expensive second-line medications. The aims of the study were to estimate the within-trial and lifetime cost-effectiveness of the weight management programme, which achieved 46% remissions of type 2 diabetes at year 1 and 36% at year 2 in the Diabetes Remission Clinical Trial (DiRECT).MethodsWithin-trial analysis assessed costs of the Counterweight-Plus intervention in DiRECT (including training, programme materials, practitioner appointments and low-energy diet), along with glucose-lowering and antihypertensive medications, and all routine healthcare contacts. Lifetime cost per quality-adjusted life-year (QALY) was estimated according to projected durations of remissions, assuming continued relapse rates as seen in year 2 of DiRECT and consequent life expectancy, quality of life and healthcare costs.ResultsMean total 2 year healthcare costs for the intervention and control groups were £3036 and £2420, respectively: an incremental cost of £616 (95% CI –£45, £1269). Intervention costs (£1411; 95% CI £1308, £1511) were partially offset by lower other healthcare costs (£796; 95% CI £150, £1465), including reduced oral glucose-lowering medications by £231 (95% CI £148, £314). Net remission at 2 years was 32.3% (95% CI 23.5%, 40.3%), and cost per remission achieved was £1907 (lower 95% CI: intervention dominates; upper 95% CI: £4212). Over a lifetime horizon, the intervention was modelled to achieve a mean 0.06 (95% CI 0.04, 0.09) QALY gain for the DiRECT population and mean total lifetime cost savings per participant of £1337 (95% CI £674, £2081), with the intervention becoming cost-saving within 6 years.Conclusions/interpretationIncorporating the lifetime healthcare cost savings due to periods of remission from diabetes and its complications, the DiRECT intervention is predicted to be both more effective (QALY gain) and cost-saving in adults with type 2 diabetes compared with standard care. This conclusion appears robust to various less favourable model scenarios, providing strong evidence that resources could be shifted cost-effectively to support achieving remissions with the DiRECT intervention.Trial registrationISRCTN03267836Graphical abstract
Highlights
Type 2 diabetes, until recently considered a permanent and inevitably progressive chronic disease, impacts rates of mortality and morbidity as well as quality of life (QoL)
The Diabetes Remission Clinical Trial (DiRECT) study has shown that durable remissions of type 2 diabetes to a non-diabetic state can be achieved through an integrated weight management programme, mostly for those achieving weight loss >10 kg, for almost half of all participants
Weight loss >15 kg in the intervention arm led to remissions for 86% at 1 year and 82% at 2 years [9]
Summary
Type 2 diabetes, until recently considered a permanent and inevitably progressive chronic disease, impacts rates of mortality and morbidity as well as quality of life (QoL). Management has usually focused on pharmacotherapy, with increasing emphasis in guidelines on earlier prescription of more modern and expensive glucose-lowering, lipidlowering and antihypertensive drugs, to control blood glucose and reduce the associated complications and elevated cardiovascular risks. Despite these treatments, younger people, in particular, commonly face irreversible declines in health from type 2 diabetes, characterised by chronic pain and multiple disabilities, and life expectancy is reduced substantially [4]. In the Diabetes Remission Clinical Trial (DiRECT), an integrated diet programme delivered entirely within primary care produced remissions of type 2 diabetes (non-diabetic HbA1c on no glucose-lowering medication) in 46% of participants at 1 year and 36% at 2 years [8, 9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
