Health Organisation, Policy and Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
Appl Health Econ Health Policy. 2023 Nov;21(6):891-903. doi: 10.1007/s40258-023-00830-8. Epub 2023 Oct 3.
Prevention programmes typically incur short-term costs and uncertain long-term benefits. We use the National Health Service (NHS) England Diabetes Prevention Programme (NHS-DPP) to investigate whether behaviour change programmes may be cost-effective even within the short-term participation period.
We analysed 384,611 referrals between June 2016 and March 2019. We estimated NHS costs using implementation costs and provider payments. We used linear regressions to relate utility changes to the number of sessions attended, based on responses to the five-level EQ-5D (EQ-5D-5L) at baseline and final session for 18,959 participants. We then calculated the corresponding quality-adjusted life year (QALY) change for all 384,611 referrals by combining the estimated regression coefficients with the observed level of attendance, with individuals that did not attend any programme sessions being assumed to experience zero benefit. In secondary analysis, we added weight change, recorded for 18,105 participants to the regression and applied predicted values to all referrals with missing weight change values estimated using multiple imputation with chained equations. We then estimated the cost-per-QALY generated.
Average cost per referral was £119 (standard deviation: £118; 2020 price year, UK £ Sterling). Each session attended was associated with a 0.0042 increase in utility (95% confidence interval (CI): 0.0025-0.0059). This generated 1,773 QALYs across all referrals (95% CI: 889-2,656). Cost-per-QALY was £24,929 (95% CI: £16,635-49,720) when implementation costs were excluded. Secondary analysis showed each session attended and kilogram of weight lost were associated with 0.0034 (95% CI: 0.0016-0.0051) and 0.0025 (95% CI: 0.0020-0.0031) increases in utility, respectively. These generated 1,542 QALYs, at a cost-per-QALY of £28,661 when implementation costs were excluded.
Participants experienced small utility gains from session attendance and weight loss during their programme participation. These benefits alone made this low-cost behaviour change programme potentially cost-effective in the short-term.
预防计划通常会产生短期成本和不确定的长期效益。我们使用英格兰国民保健服务（NHS）糖尿病预防计划（NHS-DPP）来研究行为改变计划即使在短期参与期间是否也具有成本效益。
我们分析了 2016 年 6 月至 2019 年 3 月期间的 384611 例转介。我们使用实施成本和提供者付款来估计 NHS 成本。我们使用线性回归根据基线和最终会话中 18959 名参与者的五个级别的 EQ-5D（EQ-5D-5L）响应来关联效用变化与参加的会话次数之间的关系。然后，我们通过将估计的回归系数与观察到的出勤水平结合起来，为所有 384611 例转介计算了相应的质量调整生命年（QALY）变化，对于未参加任何方案会议的个体，假定他们没有获得任何收益。在二次分析中，我们将体重变化添加到回归中，该体重变化记录于 18105 名参与者中，并且对于所有未记录体重变化值的转介使用带有连锁方程的多重插补来估计缺失值，应用预测值。然后，我们估计了产生的每 QALY 的成本。
每个转介的平均成本为 119 英镑（标准差：118 英镑；2020 年价格，英国英镑）。每次参加会议与效用增加 0.0042 相关（95%置信区间（CI）：0.0025-0.0059）。这在所有转介中产生了 1773 个 QALY（95%CI：889-2656）。排除实施成本后，每 QALY 的成本为 24929 英镑（95%CI：16635-49720）。二次分析表明，每次参加会议和减轻一公斤体重与效用分别增加 0.0034（95%CI：0.0016-0.0051）和 0.0025（95%CI：0.0020-0.0031）相关。排除实施成本后，这些产生了 1542 个 QALY，每 QALY 的成本为 28661 英镑。
参与者在参与计划期间从会议出勤和体重减轻中获得了较小的效用收益。仅凭这些收益，这项低成本的行为改变计划在短期内就具有潜在的成本效益。
