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Cost‐effectiveness of the psycho‐educational blended (group and online) intervention HypoAware compared with usual care for people with Type 1 and insulin‐treated Type 2 diabetes with problematic hypoglycaemia: analyses of a cluster‐randomized controlled trial
Author(s) -
Wit M.,
Rondags S. M. P. A.,
Tulder M. W.,
Snoek F. J.,
Bosmans J. E.
Publication year - 2018
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.13548
Subject(s) - medicine , cost effectiveness , quality of life (healthcare) , randomized controlled trial , type 1 diabetes , willingness to pay , cost effectiveness analysis , quality adjusted life year , health care , type 2 diabetes , incremental cost effectiveness ratio , diabetes mellitus , nursing , endocrinology , risk analysis (engineering) , microeconomics , economic growth , economics
Aims To evaluate the cost‐effectiveness of HypoAware, a blended (group and online) psycho‐educational intervention based on the evidence‐based Blood Glucose Awareness Training, in comparison with usual care in people with Type 1 and Type 2 diabetes with a high risk of severe hypoglycaemia. Methods We performed an economic evaluation, from a societal and healthcare perspective, that used data from a 6‐month, multicentre, cluster‐randomized controlled trial ( n = 137). Results The proportion of people with at least one severe hypoglycaemic event per 6 months was 0.22 lower (95% CI –0.39 to –0.06) and the proportion of people with impaired hypoglycaemia awareness was 0.16 lower (95% CI –0.34 to 0.02) in the HypoAware group. There was no difference in quality‐adjusted life‐years (–0.0; 95% CI –0.05 to 0.05). The mean total societal costs in the HypoAware group were EUR 708 higher than in the usual care group (95% CI –951 to 2298). The mean incremental cost per severe hypoglycaemic event prevented was EUR 2,233. At a willingness‐to‐pay threshold of EUR 20,000 per event prevented, the probability that HypoAware was cost‐effective in comparison with usual care was 54% from a societal perspective and 55% from a healthcare perspective. For quality‐adjusted life‐years the incremental cost‐effectiveness ratio was EUR 119,360/quality‐adjusted life‐year gained and the probability of cost‐effectiveness was low at all ceiling ratios. Conclusions Based on the present study, we conclude that HypoAware is not cost‐effective compared to usual care. Further research in less well‐resourced settings and more severely affected patients is warranted. (Clinical Trials Registry no: Dutch Trial Register NTR 4538.)