Delivering Diabetes Education through Nurse-Led Telecoaching. Cost-Effectiveness Analysis

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Abstract

Background

People with diabetes have a high risk of developing micro- and macrovascular complications associated with diminished life expectancy and elevated treatment costs. Patient education programs can improve diabetes control in the short term, but their cost-effectiveness is uncertain. Our study aimed to analyze the lifelong cost-effectiveness of a nurse-led telecoaching program compared to usual care in people with type 2 diabetes from the perspective of the Belgian healthcare system.

Methods

The UKPDS Outcomes Model was populated with patient-level data from an 18-month randomized clinical trial in the Belgian primary care sector involving 574 participants; trial data were extrapolated to 40 years; Quality Adjusted Life Years (QALYs), treatment costs and Incremental Cost-Effectiveness Ratio (ICER) were calculated for the entire cohort and the subgroup with poor glycemic control at baseline (“elevated HbA1c subgroup”) and the associated uncertainty was explored.

Results

The cumulative mean QALY (95% CI) gain was 0.21 (0.13; 0.28) overall and 0.56 (0.43; 0.68) in elevated HbA1c subgroup; the respective incremental costs were €1,147 (188; 2,107) and €2,565 (654; 4,474) and the respective ICERs €5,569 (€677; €15,679) and €4,615 (1,207; 9,969) per QALY. In the scenario analysis, repeating the intervention for lifetime had the greatest impact on the cost-effectiveness and resulted in the mean ICERs of €13,034 in the entire cohort and €7,858 in the elevated HbA1c subgroup.

Conclusion

Taking into account reimbursement thresholds applied in West-European countries, nurse-led telecoaching of people with type 2 diabetes may be considered highly cost-effective within the Belgian healthcare system.

Trial registration

NCT01612520

Related collections

Most cited references 38

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Group based training for self-management strategies in people with type 2 diabetes mellitus.

T. Williams, Richard Cade, Claire T. Deakin … (2005)

It has been recognised that adoption of self-management skills by the person with diabetes is necessary in order to manage their diabetes. However, the most effective method for delivering education and teaching self-management skills is unclear. To assess the effects of group-based, patient-centred training on clinical, lifestyle and psychosocial outcomes in people with type 2 diabetes. Studies were obtained from computerised searches of multiple electronic bibliographic databases, supplemented by hand searches of reference lists of articles, conference proceedings and consultation with experts in the field. Date of last search was February 2003. Randomised controlled and controlled clinical trials which evaluated group-based education programmes for adults with type 2 diabetes compared with routine treatment, waiting list control or no intervention. Studies were only included if the length of follow-up was six months or more and the intervention was at least one session with the minimum of six participants. Two reviewers independently extracted data and assessed study quality. A meta-analysis was performed if there were enough homogeneous studies reporting an outcome at either four to six months, 12-14 months, or two years, otherwise the studies were summarised in a descriptive manner. Fourteen publications describing 11 studies were included involving 1532 participants. The results of the meta-analyses in favour of group-based diabetes education programmes were reduced glycated haemoglobin at four to six months (1.4%; 95% confidence interval (CI) 0.8 to 1.9; P < 0.00001), at 12-14 months (0.8%; 95% CI 0.7 to 1.0; P < 0.00001) and two years (1.0%; 95% CI 0.5 to 1.4; P < 0.00001); reduced fasting blood glucose levels at 12 months (1.2 mmol/L; 95% CI 0.7 to 1.6; P < 0.00001); reduced body weight at 12-14 months (1.6 Kg; 95% CI 0.3 to 3.0; P = 0.02); improved diabetes knowledge at 12-14 months (SMD 1.0; 95% CI 0.7 to 1.2; P < 0.00001) and reduced systolic blood pressure at four to six months (5 mmHg: 95% CI 1 to 10; P = 0.01). There was also a reduced need for diabetes medication (odds ratio 11.8, 95% CI 5.2 to 26.9; P < 0.00001; RD = 0.2; NNT = 5). Therefore, for every five patients attending a group-based education programme we could expect one patient to reduce diabetes medication. Group-based training for self-management strategies in people with type 2 diabetes is effective by improving fasting blood glucose levels, glycated haemoglobin and diabetes knowledge and reducing systolic blood pressure levels, body weight and the requirement for diabetes medication.

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The 10-Year Cost-Effectiveness of Lifestyle Intervention or Metformin for Diabetes Prevention

(2012)

OBJECTIVE The Diabetes Prevention Program (DPP) and its Outcomes Study (DPPOS) demonstrated that either intensive lifestyle intervention or metformin could prevent type 2 diabetes in high-risk adults for at least 10 years after randomization. We report the 10-year within-trial cost-effectiveness of the interventions. RESEARCH DESIGN AND METHODS Data on resource utilization, cost, and quality of life were collected prospectively. Economic analyses were performed from health system and societal perspectives. RESULTS Over 10 years, the cumulative, undiscounted per capita direct medical costs of the interventions, as implemented during the DPP, were greater for lifestyle ($4,601) than metformin ($2,300) or placebo ($769). The cumulative direct medical costs of care outside the DPP/DPPOS were least for lifestyle ($24,563 lifestyle vs. $25,616 metformin vs. $27,468 placebo). The cumulative, combined total direct medical costs were greatest for lifestyle and least for metformin ($29,164 lifestyle vs. $27,915 metformin vs. $28,236 placebo). The cumulative quality-adjusted life-years (QALYs) accrued over 10 years were greater for lifestyle (6.81) than metformin (6.69) or placebo (6.67). When costs and outcomes were discounted at 3%, lifestyle cost $10,037 per QALY, and metformin had slightly lower costs and nearly the same QALYs as placebo. CONCLUSIONS Over 10 years, from a payer perspective, lifestyle was cost-effective and metformin was marginally cost-saving compared with placebo. Investment in lifestyle and metformin interventions for diabetes prevention in high-risk adults provides good value for the money spent.

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Multiple criteria decision analysis for health technology assessment.

Alejandra Duenas, Praveen Thokala (2012)

Multicriteria decision analysis (MCDA) has been suggested by some researchers as a method to capture the benefits beyond quality adjusted life-years in a transparent and consistent manner. The objectives of this article were to analyze the possible application of MCDA approaches in health technology assessment and to describe their relative advantages and disadvantages. This article begins with an introduction to the most common types of MCDA models and a critical review of state-of-the-art methods for incorporating multiple criteria in health technology assessment. An overview of MCDA is provided and is compared against the current UK National Institute for Health and Clinical Excellence health technology appraisal process. A generic MCDA modeling approach is described, and the different MCDA modeling approaches are applied to a hypothetical case study. A comparison of the different MCDA approaches is provided, and the generic issues that need consideration before the application of MCDA in health technology assessment are examined. There are general practical issues that might arise from using an MCDA approach, and it is suggested that appropriate care be taken to ensure the success of MCDA techniques in the appraisal process. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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Author and article information

Contributors

Noel Christopher Barengo: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 11 October 2016

Publication date Collection: 2016

Volume: 11

Issue: 10

Electronic Location Identifier: e0163997

Affiliations

[1 ]Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium

[2 ]Department of Endocrinology, OLV Hospital Aalst, Aalst, Belgium

[3 ]Academic Center for General Practice, KU Leuven, Leuven, Belgium

[4 ]Department of Public Health, Ghent University, Ghent, Belgium

Florida International University Herbert Wertheim College of Medicine, UNITED STATES

Author notes

Competing Interests: IO conducted this project in her position as Innovation Manager of the Independent Health Insurance Fund of Belgium and as part of her PhD at the University of Leuven. No competing interests were declared by other co-authors.

Conceptualization: IO DR BA LA.
Data curation: IO.
Formal analysis: IO.
Investigation: IO.
Methodology: IO DR FN GG BA LA.
Project administration: IO.
Resources: IO.
Supervision: DR BA LA.
Validation: IO DR FN GG BA LA.
Visualization: IO DR FN GG BA LA.
Writing – original draft: IO.
Writing – review & editing: IO DR FN GG BA LA.

* E-mail: irina.v.odnoletkova@ 123456gmail.com

Article

Publisher ID: PONE-D-16-15435

DOI: 10.1371/journal.pone.0163997

PMC ID: 5058491

PubMed ID: 27727281

SO-VID: f45c15e8-cd42-414b-922d-7e09104d3398

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 16 April 2016

Date accepted : 19 September 2016

Page count

Figures: 5, Tables: 7, Pages: 18

Funding

The authors received no specific funding for this work. During the study, IO was a salaried employee of the Independent Health Insurance Fund of Belgium. The funding source played no role in any part of the study.

Custom metadata

Data Availability The corresponding author may be contacted with a request of anonymised clinical and health insurance data of the trial participants (available in a spreadsheet format).

Delivering Diabetes Education through Nurse-Led Telecoaching. Cost-Effectiveness Analysis

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Abstract

Background

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Trial registration

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PLOS Climate

Most cited references 38

Group based training for self-management strategies in people with type 2 diabetes mellitus.

The 10-Year Cost-Effectiveness of Lifestyle Intervention or Metformin for Diabetes Prevention

Multiple criteria decision analysis for health technology assessment.

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