Table 8 Cost-effectiveness Outcomes: Diabetes
Authors, Year | Type of Analysis | Type of Costs | Costs | Type of effectiveness outcome | Effectiveness | ICER | Sensitivity Analysis Used | WTP Threshold(s) (CEAC range) | Probability Cost Effective at Threshold(s) | Authors conclude (Reviewer comments where these differ from authors) |
|---|---|---|---|---|---|---|---|---|---|---|
Camacho et al. 2016 [39*] | CUA (Markov model) extrapolated from trial data | Mean (unadjusted costs) | Intervention: £1896 (95% CI 1468 to 2224); Control: £1515, (95% CI 1205 to 1826) | Mean depressions score at follow up | 0.23 points lower (95% confidence interval − 0.41 to −0.05) in participants who received collaborative care compared with those who received usual care. | ICER (cost per QALY gained - model-based): | £16,123 | Parameters varied in sensitivity analysis | Time horizon, excluding training costs, excluding deaths, change to waning of treatment benefit over time, discount rate. | Collaborative care may also be cost-effective in the English health service for patient groups with depression in conjunction with long-term physical health conditions, and over a long-term time horizon. However, the long-term findings were extrapolated from 4-month trial data and so associated with some uncertainty |
Healthcare usage costs (net cost for collaborative care compared with control) | £674 (95% CI −30,953 to 38,853) | Net QALY gain | 0.04 (95% CI −0.46 to 0.54); No significant differences between groups for disability, self efficacy, illness perceptions, and global quality of life or for disease specific quality of life | ICER (cost per QALY gained) within-trial data: | £29,132 | WTP Threshold(s) | £15,000, £20,000, £60,000 | |||
Intervention costs (including PWP training, clinical and admin time and supervision costs) | Intervention: £318; Control: N/A | Probability treatment is cost effective at WTP threshold(s) | Model-based: 0.53 at £15,000, 0.54 at £20,000, 0.56 at £60,000. Within-trial analysis: 0.49 at £20,000. | |||||||
Ismail et al. 2018 [57*] | CEA (point improvement in HbA1c) and CUA (SF-12) | Adjusted mean difference in total health & social care costs at 18 months (including intervention costs and discounting non-intervention costs): | £150 (95% CI = −34 to 333) | Mean difference in HbA1c | −0.79 mmol/mol (95% confidence interval CI = −5.75 to 4.18). No significant difference between intervention and standard care | ICER (cost per unit change in HbA1c): | Not reported. Cost effectiveness plane shown in supplementary files. | WTP threshold(s) | £0 to £50,000 | Unlikely to be cost-effective |
Mean difference in intervention costs | £276 (95% CI = 225 to 327) | SF-12 | No significant difference between intervention and standard care for any of the secondary outcomes | ICER (cost per QALY gained): | Not reported. Cost effectiveness plane shown in supplementary files. | Probability treatment is cost effective at WTP threshold(s) | 5% at £0 WTP, 65% at £5000 and at £50,000 (HbA1c); Did not exceed 35% at any WTP threshold (QALYs). | |||
Nobis et al., 2018 [81*] | EQ-5D-3L | Total costs | Intervention: €5195; Control: €5098; Mean costs were therefore €97 higher in the intervention group than in the control group after 6 months. | % showing treatment response at six months | Intervention: 77 (60%) Control: 23 (18%) | ICER (cost per treatment response): | €233 | Bootstrapping (Y/N; replications): | Y (2500 replications) | Demonstrated a high probability of being cost-effective compared with an active control group. |
Intervention costs | Intervention: €283.46; Control: €33.10 | QALYs gained at six months | Intervention: 0.33 (s.d. = 0.11) Control: 0.32 (s.d. = 0.11) No significant differences were found between the groups (p = 0.51) at six months | ICER (cost per QALY gained): | € 10,708 | WTP threshold(s) | €5000, €14,000 | |||
Probability treatment is cost effective at WTP threshold(s) | 97% at €5000 (treatment response), 51% at €14,000 (per QALY gained). |