Type 2 diabetes remission: 2 year within-trial and lifetime-horizon cost-effectiveness of the Diabetes Remission Clinical Trial (DiRECT)/Counterweight-Plus weight management programme
Open accessAbstract
Aims/hypothesis: Approximately 10% of total healthcare budgets worldwide are spent on treating diabetes and its complications, and budgets are increasing globally because of ageing populations and more expensive second-line medications. The aims of the study were to estimate the within-trial and lifetime cost-effectiveness of the weight management programme, which achieved 46% remissions of type 2 diabetes at year 1 and 36% at year 2 in the Diabetes Remission Clinical Trial (DiRECT). Methods: Within-trial analysis assessed costs of the Counterweight-Plus intervention in DiRECT (including training, programme materials, practitioner appointments and low-energy diet), along with glucose-lowering and antihypertensive medications, and all routine healthcare contacts. Lifetime cost per quality-adjusted life-year (QALY) was estimated according to projected durations of remissions, assuming continued relapse rates as seen in year 2 of DiRECT and consequent life expectancy, quality of life and healthcare costs. Results: Mean total 2 year healthcare costs for the intervention and control groups were £3036 and £2420, respectively: an incremental cost of £616 (95% CI –£45, £1269). Intervention costs (£1411; 95% CI £1308, £1511) were partially offset by lower other healthcare costs (£796; 95% CI £150, £1465), including reduced oral glucose-lowering medications by £231 (95% CI £148, £314). Net remission at 2 years was 32.3% (95% CI 23.5%, 40.3%), and cost per remission achieved was £1907 (lower 95% CI: intervention dominates; upper 95% CI: £4212). Over a lifetime horizon, the intervention was modelled to achieve a mean 0.06 (95% CI 0.04, 0.09) QALY gain for the DiRECT population and mean total lifetime cost savings per participant of £1337 (95% CI £674, £2081), with the intervention becoming cost-saving within 6 years. Conclusions/interpretation: Incorporating the lifetime healthcare cost savings due to periods of remission from diabetes and its complications, the DiRECT intervention is predicted to be both more effective (QALY gain) and cost-saving in adults with type 2 diabetes compared with standard care. This conclusion appears robust to various less favourable model scenarios, providing strong evidence that resources could be shifted cost-effectively to support achieving remissions with the DiRECT intervention. Trial registration: ISRCTN03267836
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For diabetes remission, a total diet replacement programme was estimated to be both more cost-effective and cost-saving than standard care in the DiRECT trial, reflecting reduced need for medications and fewer diabetes complications.
“For diabetes remission, a total diet replacement programme was estimated to be both more cost-effective and cost-saving than standard care in the DiRECT trial, reflecting reduced need for medications and fewer diabetes complications [63].”
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Cites
Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery
Sjöström, L., Lindroos, A.-K., Peltonen, M., Torgerson, J., Bouchard, C., Carlsson, B., Dahlgren, S., Larsson, B., Narbro, K., Sjöström, C. D., et al. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa035622 · Cited by 4,457 · see citing works
Zhou, B., Lu, Y., Hajifathalian, K., Bentham, J., Di Cesare, M., Danaei, G., Bixby, H., Cowan, M., Ali, M., Taddei, C., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)00618-8 · Cited by 4,311 · see citing works
Economic Costs of Diabetes in the U.S. in 2002
American Diabetes Association (2003) · Diabetes Care · doi:10.2337/diacare.26.3.917 · Cited by 4,147 · see citing works
Decision Modelling For Health Economic Evaluation
Briggs, A., Claxton, K., & Sculpher, M. (2006) · doi:10.1093/oso/9780198526629.001.0001 · Cited by 3,153 · see citing works
Self-citationDiabetes Mellitus, Fasting Glucose, and Risk of Cause-Specific Death
The Emerging Risk Factors Collaboration (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1008862 · Cited by 2,726 · see citing works
Economic Costs of Diabetes in the U.S. in 2017
American Diabetes Association (2018) · Diabetes Care · doi:10.2337/dci18-0007 · Cited by 2,528 · see citing works
Lean, M. E., Leslie, W. S., Barnes, A. C., Brosnahan, N., Thom, G., McCombie, L., Peters, C., Zhyzhneuskaya, S., Al-Mrabeh, A., Hollingsworth, K. G., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(17)33102-1 · Cited by 2,095 · see citing works
Self-citationLim, E. L., Hollingsworth, K. G., Aribisala, B. S., Chen, M. J., Mathers, J. C., & Taylor, R. (2011) · Diabetologia · doi:10.1007/s00125-011-2204-7 · Cited by 1,164 · see citing works
Self-citationLean, M. E. J., Leslie, W. S., Barnes, A. C., Brosnahan, N., Thom, G., McCombie, L., Peters, C., Zhyzhneuskaya, S., Al-Mrabeh, A., Hollingsworth, K. G., et al. (2019) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(19)30068-3 · Cited by 981 · see citing works
Self-citationEight-year weight losses with an intensive lifestyle intervention: The look AHEAD study
The Look AHEAD Research Group (2014) · Obesity · doi:10.1002/oby.20662 · Cited by 842 · see citing works
Type 2 diabetes in adolescents and young adults
Lascar, N., Brown, J., Pattison, H., Barnett, A. H., Bailey, C. J., & Bellary, S. (2018) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(17)30186-9 · Cited by 824 · see citing works
Hex, N., Bartlett, C., Wright, D., Taylor, M., & Varley, D. (2012) · Diabetic Medicine · doi:10.1111/j.1464-5491.2012.03698.x · Cited by 819 · see citing works
A comparison of two sources of primary and social care resource use data in a care home setting
Sach, T., Desborough, J. A., Houghton, J., & Holland, R. (2018) · ePrints Soton (University of Southampton) · doi:10.22024/unikent/01.02.70995 · Cited by 435 · see citing works
Steven, S., Hollingsworth, K. G., Al-Mrabeh, A., Avery, L., Aribisala, B., Caslake, M., & Taylor, R. (2016) · Diabetes Care · doi:10.2337/dc15-1942 · Cited by 418 · see citing works
Global epidemiology of prediabetes - present and future perspectives
Gottwald‐Hostalek, U. (2019) · Clinical Diabetes and Endocrinology · doi:10.1186/s40842-019-0080-0 · Cited by 395 · see citing works
Catalogue of EQ-5D Scores for the United Kingdom
Sullivan, P. W., Slejko, J. F., Sculpher, M. J., & Ghushchyan, V. H. (2011) · Medical Decision Making · doi:10.1177/0272989x11401031 · Cited by 364 · see citing works
Populating an Economic Model with Health State Utility Values: Moving toward Better Practice
Ara, R., & Brazier, J. (2010) · Value in Health · doi:10.1111/j.1524-4733.2010.00700.x · Cited by 334 · see citing works
Prevalence of prediabetes in England from 2003 to 2011: population-based, cross-sectional study
Mainous, A. G., Tanner, R., Baker, R., Zayas, C. E., & Harle, C. A. (2014) · BMJ Open · doi:10.1136/bmjopen-2014-005002 · Cited by 190 · see citing works
The Control of Diabetes Mellitus (NIDDM) in the Morbidly Obese with the Greenville Gastric Bypass
Pories, W. J., CARD, J. F., Flickinger, E. G., MEELHEIM, H. D., & Swanson, M. S. (1987) · Annals of Surgery · doi:10.1097/00000658-198709000-00009 · Cited by 185 · see citing works
The Diabetes Remission Clinical Trial (DiRECT): protocol for a cluster randomised trial
Leslie, W. S., Ford, I., Sattar, N., Hollingsworth, K. G., Adamson, A., Sniehotta, F. F., McCombie, L., Brosnahan, N., Ross, H., Mathers, J. C., et al. (2016) · BMC Family Practice · doi:10.1186/s12875-016-0406-2 · Cited by 132 · see citing works
Self-citationNagi, D. K., Hambling, C. E., & Taylor, R. (2019) · British Journal of Diabetes · doi:10.15277/bjd.2019.221 · Cited by 82 · see citing works
Self-citationWalker, J. J., Colhoun, H. M., Livingstone, S. J., McCrimmon, R. J., Petrie, J. R., Sattar, N. A., & Wild, S. H. (2017) · Diabetologia · doi:10.1007/s00125-017-4478-x · Cited by 60 · see citing works
Roberts, S., Craig, D., Adler, A., McPherson, K., & Greenhalgh, T. (2018) · BMC Medicine · doi:10.1186/s12916-017-0984-4 · Cited by 48 · see citing works
Xin, Y., Davies, A., McCombie, L., Briggs, A., Messow, C.-M., Grieve, E., Leslie, W. S., Taylor, R., & Lean, M. E. J. (2019) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(18)30346-2 · Cited by 32 · see citing works
Self-citationXin, Y., Davies, A., McCombie, L., Briggs, A. H., Messow, C., Grieve, E., Leslie, W. S., Taylor, R., & Lean, M. E. J. (2019) · Diabetic Medicine · doi:10.1111/dme.13981 · Cited by 26 · see citing works
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Churuangsuk, C., Hall, J., Reynolds, A., Griffin, S. J., Combet, E., & Lean, M. E. J. (2022) · Diabetologia · doi:10.1007/s00125-021-05577-2 · Cited by 204 · see citing works
Self-citationTreating chronic diseases without tackling excess adiposity promotes multimorbidity
Sattar, N., McMurray, J. J. V., McInnes, I. B., Aroda, V. R., & Lean, M. E. J. (2023) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(22)00317-5 · Cited by 69 · see citing works
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- Authors
- Xin, Y., Davies, A., Briggs, A., McCombie, L., Messow, C. M., Grieve, E., Leslie, W. S., Taylor, R., & Lean, M. E. J.
- Affiliations
- University of Glasgow (GB)
- London School of Hygiene & Tropical Medicine (GB)
- Glasgow Royal Infirmary (GB)
- Newcastle University (GB)
- Corresponding author
- Lean, Michael E. J.
- ORCID
- Venue
- Diabetologia
- Published
- 2020-08-10
- Volume
- 63
- Issue
- 10
- Pages
- 2112-2122
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- PMC
- PMC7476973
- OpenAlex
- W3039878045
- Cited by
- 52
- References
- 25
- Citations by year
- 2026: 8 · 2025: 12 · 2024: 3 · 2023: 10 · 2022: 7 · 2021: 9 · 2020: 3
- FWCI
- 6.17
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Diabetologia (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Funders
- University of Glasgow
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Keywords
- type 2 diabetes remission, cost-effectiveness, remission duration, relapse rate, hypocaloric diet, health care costs, quality-adjusted life years, weight loss interventions
- MeSH terms
- Obesity Management, Antihypertensive Agents, Cost-Benefit Analysis, Diabetes Mellitus, Type 2, Female, United Kingdom, Humans, Hypoglycemic Agents, Male, Middle Aged, Obesity, Remission Induction, Health Care Costs, Quality-Adjusted Life Years, Caloric Restriction, Overweight
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