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The cost‐effectiveness of the Dose Adjustment for Normal Eating ( DAFNE ) structured education programme: an update using the Sheffield Type 1 Diabetes Policy Model
Author(s) -
Kruger J.,
Brennan A.,
Thokala P.,
Basarir H.,
Jacques R.,
Elliott J.,
Heller S.,
Speight J.
Publication year - 2013
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12270
Subject(s) - medicine
Aims To estimate the cost‐effectiveness of training in flexible intensive insulin therapy [as provided in the Dose Adjustment for Normal Eating ( DAFNE ) structured education programme] compared with no training for adults with Type 1 diabetes mellitus in the UK using the Sheffield Type 1 Diabetes Policy Model. Methods The Sheffield Type 1 Diabetes Policy Model was used to simulate the development of long‐term microvascular and macrovascular diabetes‐related complications and the occurrence of diabetes‐related adverse events in 5000 adults with Type 1 diabetes. Total costs and quality‐adjusted life years were estimated from a National Health Service perspective over a lifetime horizon, discounted at a rate of 3.5%. The treatment effectiveness of DAFNE was modelled as a reduction in HbA 1c that affected the risk of developing long‐term diabetes‐related complications. Probabilistic and structural sensitivity analyses were conducted. Results DAFNE resulted in greater life expectancy and reduced incidence of some diabetes‐related complications compared with no DAFNE . DAFNE was found to generate an average of 0.0294 additional quality‐adjusted life years for an additional cost of £426 per patient, leading to an incremental cost‐effectiveness ratio of £14 400 compared with no DAFNE . There was a 54% probability that DAFNE would be cost‐effective at a willingness‐to‐pay threshold of £20 000 per quality‐adjusted life year. Conclusions The results of this study suggest that DAFNE is a cost‐effective structured education programme for people with Type 1 diabetes and support its provision by the National Health Service in the UK .