Is there a diabetes pay-off?

13/10/2017 - 11:24
Can the NHS Diabetes Prevention Programme raise life expectancy and save money? The results of a recent study suggest it could, reports David Foad.

With an estimated 2.8 million people in the UK suffering type 2 diabetes plus around 200,000 new diagnoses each year, the NHS, working with Public Health England and Diabetes UK, launched the Diabetes Prevention Programme (DPP) in 2016.

The aim was to identify those at high risk and refer them to a behaviour-change programme.

The first wave of 27 areas covering 26 million people, half of the population, made up to 20,000 places available. This is now being rolled out to the whole country, with an expected 100,000 referrals available each year.

Those referred get tailored, personalised help to reduce their risk of type 2 diabetes, including education on healthy eating and lifestyle, help to lose weight, and bespoke physical exercise programmes.

Now the University of Sheffield’s School of Health and Related Research has published the results of an assessment of the economic value of the programme, and it suggests that the intervention costs of the DPP will be recouped through NHS savings within 12 years, with a net saving of £1.28 over 20 years for each £1 invested.

It has also estimated which population subgroups are likely to benefit most in terms of cost-effectiveness, cost savings and health benefits. It measures the health benefits in quality-adjusted life-years (QALYs).

The report’s authors explain: “The DPP is likely to be cost-effective and cost-saving under current assumptions. Prioritising obese individuals could create the most value for money and obtain the greatest health benefits per individual targeted.

“Low socioeconomic status or ethnic minority groups may gain fewer QALYs per intervention, so targeting strategies should ensure the DPP does not contribute to widening health inequalities.

“Further evidence is needed around the differential responsiveness of population subgroups to the DPP.”

Those referred to the programme were aged 16 or more with a high risk of type 2 diabetes. The population subgroups were based on age, sex, ethnicity, socioeconomic deprivation, baseline body mass index, baseline HbA1c (glycated haemoglobin) and working status.

What they received was described as “an intensive lifestyle intervention focusing on dietary advice, physical activity and weight loss”.

The assessment compared them with a similar group offered no diabetes prevention intervention.

It showed that for every 100,000 DPP interventions given to those at risk, there will be a gain of an extra 3,552 years of good health.

The authors say the best returns on investment come with obese individuals, those with moderately raised blood glucose levels and those aged 40-74.

The QALY gains are lower in minority ethnic and low socioeconomic status subgroups.

The authors conclude that the DPP will almost certainly prove cost-effective over a 20-year period.

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