McManus Emma
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, Suite 12, Floor 7, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
Pharmacoecon Open. 2024 Jul;8(4):569-583. doi: 10.1007/s41669-024-00487-6. Epub 2024 Apr 20.
In 2016, England launched the largest nationwide diabetes mellitus prevention programme, the NHS Diabetes Prevention Programme (NHS DPP). This paper seeks to evaluate the long-term cost-effectiveness of this programme.
A Markov cohort state transition model was developed with a 35-year time horizon and yearly cycles to compare referral to the NHS DPP to usual care for individuals with non-diabetic hyperglycaemia. The modelled cohort of individuals mirrored the age profile of referrals received by the programme by April 2020. A health system perspective was taken, with costs in UK £ Sterling (price year 2020) and outcomes in terms of quality-adjusted life-years (QALYs). Probabilistic analysis with 10,000 Monte Carlo simulations was used. Several sensitivity analyses were conducted to explore the uncertainty surrounding the base case results, particularly varying the length of time for which the effectiveness of the programme was expected to last.
In the base case, using only the observed effectiveness of the NHS DPP at 3 years, it was found that the programme is likely to dominate usual care, by generating on average 40.8 incremental QALYs whilst saving £135,755 in costs for a cohort of 1000. At a willingness to pay of £20,000 per QALY, 98.1% of simulations were on or under the willingness-to-pay threshold. Scaling this up to the number of referrals actually received by the NHS DPP prior to April 2020, cost savings of £71.4 million were estimated over the 35-year time horizon and an additional 21,472 QALYs generated. These results are robust to several sensitivity analyses.
The NHS DPP is likely to be cost-effective. Indeed, in the majority of the simulations, the NHS DPP was cost-saving and generated greater QALYs, dominating usual care. This research should serve as evidence to support the continued investment or recommissioning of diabetes prevention programmes.
2016年，英国启动了规模最大的全国性糖尿病预防项目——国民保健服务糖尿病预防项目（NHS DPP）。本文旨在评估该项目的长期成本效益。
构建了一个马尔可夫队列状态转换模型，时间跨度为35年，每年为一个周期，以比较将非糖尿病性高血糖个体转介至NHS DPP与常规护理的情况。模拟队列的个体反映了截至2020年4月该项目所接收转介患者的年龄分布。采用卫生系统视角，成本以英镑（2020年价格）计算，结果以质量调整生命年（QALYs）衡量。使用了10000次蒙特卡洛模拟进行概率分析。进行了多项敏感性分析，以探讨围绕基础案例结果的不确定性，特别是改变该项目预期有效的持续时间。
在基础案例中，仅使用NHS DPP在3年时观察到的效果，发现该项目可能优于常规护理，对于1000人的队列，平均产生40.8个增量QALYs，同时节省成本135755英镑。在每QALY支付意愿为20000英镑的情况下，98.1%的模拟结果处于或低于支付意愿阈值。将此扩大到2020年4月之前NHS DPP实际接收的转介数量，估计在35年的时间跨度内可节省成本7140万英镑，并产生额外的21472个QALYs。这些结果在多项敏感性分析中具有稳健性。
NHS DPP可能具有成本效益。事实上，在大多数模拟中，NHS DPP节省了成本并产生了更多的QALYs，优于常规护理。本研究应作为证据，支持对糖尿病预防项目的持续投资或重新委托开展。
