Heathcote Laura Ellen, Pollard Daniel J, Brennan Alan, Davies Melanie J, Eborall Helen, Edwardson Charlotte L, Gillett Michael, Gray Laura J, Griffin Simon J, Hardeman Wendy, Henson Joseph, Khunti Kamlesh, Sharp Stephen, Sutton Stephen, Yates Thomas
School for Health and Related Research, The University of Sheffield, Sheffield, UK
School for Health and Related Research, The University of Sheffield, Sheffield, UK.
BMJ Open Diabetes Res Care. 2024 Mar 12;12(2):e003516. doi: 10.1136/bmjdrc-2023-003516.
Physical activity (PA) is protective against type 2 diabetes (T2D). However, data on pragmatic long-term interventions to reduce the risk of developing T2D via increased PA are lacking. This study investigated the cost-effectiveness of a pragmatic PA intervention in a multiethnic population at high risk of T2D.
We adapted the School for Public Health Research diabetes prevention model, using the PROPELS trial data and analyses of the NAVIGATOR trial. Lifetime costs, lifetime quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each intervention (Walking Away (WA) and Walking Away Plus (WA+)) versus usual care and compared with National Institute for Health and Care Excellence's willingness-to-pay of £20 000-£30 000 per QALY gained. We conducted scenario analyses on the outcomes of the PROPELS trial data and a threshold analysis to determine the change in step count that would be needed for the interventions to be cost-effective.
Estimated lifetime costs for usual care, WA, and WA+ were £22 598, £23 018, and £22 945, respectively. Estimated QALYs were 9.323, 9.312, and 9.330, respectively. WA+ was estimated to be more effective and cheaper than WA. WA+ had an ICER of £49 273 per QALY gained versus usual care. In none of our scenario analyses did either WA or WA+ have an ICER below £20 000 per QALY gained. Our threshold analysis suggested that a PA intervention costing the same as WA+ would have an ICER below £20 000/QALY if it were to achieve an increase in step count of 500 steps per day which was 100% maintained at 4 years.
We found that neither WA nor WA+ was cost-effective at a limit of £20 000 per QALY gained. Our threshold analysis showed that interventions to increase step count can be cost-effective at this limit if they achieve greater long-term maintenance of effect.
ISRCTN registration: ISRCTN83465245: The PRomotion Of Physical activity through structuredEducation with differing Levels of ongoing Support for those with pre-diabetes (PROPELS)https://doi.org/10.1186/ISRCTN83465245.
体育活动（PA）对2型糖尿病（T2D）具有预防作用。然而，关于通过增加体育活动来降低患T2D风险的实用长期干预措施的数据却很匮乏。本研究调查了一项针对T2D高风险多民族人群的实用体育活动干预措施的成本效益。
我们采用公共卫生研究糖尿病预防模型，利用PROPELS试验数据和NAVIGATOR试验分析结果。计算了每种干预措施（“走开”（WA）和“走开加”（WA+））与常规护理相比的终身成本、终身质量调整生命年（QALY）和增量成本效益比（ICER），并与英国国家卫生与临床优化研究所每获得一个QALY愿意支付20000至30000英镑的标准进行比较。我们对PROPELS试验数据的结果进行了情景分析和阈值分析，以确定干预措施具有成本效益所需的步数变化。
常规护理、WA和WA+的估计终身成本分别为22598英镑、23018英镑和22945英镑。估计的QALY分别为9.323、9.312和9.330。估计WA+比WA更有效且成本更低。与常规护理相比，WA+每获得一个QALY的ICER为49273英镑。在我们所有的情景分析中，WA或WA+每获得一个QALY的ICER均未低于20000英镑。我们的阈值分析表明，如果一项体育活动干预措施与WA+成本相同，且能使步数每天增加500步，并在4年时100%保持这一增加量，那么其ICER将低于20000英镑/QALY。
我们发现，在每获得一个QALY的成本上限为20000英镑的情况下，WA和WA+均不具有成本效益。我们的阈值分析表明，如果增加步数的干预措施能实现更大程度的长期效果维持，那么在这一成本上限下它们可能具有成本效益。
ISRCTN注册：ISRCTN83465245：通过对糖尿病前期患者进行不同程度持续支持的结构化教育促进体育活动（PROPELS）https://doi.org/10.1186/ISRCTN83465245 。
