Evaluating the Long-Term Cost-Effectiveness of the English NHS Diabetes Prevention Programme using a Markov Model
Open accessAbstract
BACKGROUND: In 2016, England launched the largest nationwide diabetes mellitus prevention programme, the NHS Diabetes Prevention Programme (NHS DPP). This paper seeks to evaluate the long-term cost-effectiveness of this programme. METHODS: A Markov cohort state transition model was developed with a 35-year time horizon and yearly cycles to compare referral to the NHS DPP to usual care for individuals with non-diabetic hyperglycaemia. The modelled cohort of individuals mirrored the age profile of referrals received by the programme by April 2020. A health system perspective was taken, with costs in UK £ Sterling (price year 2020) and outcomes in terms of quality-adjusted life-years (QALYs). Probabilistic analysis with 10,000 Monte Carlo simulations was used. Several sensitivity analyses were conducted to explore the uncertainty surrounding the base case results, particularly varying the length of time for which the effectiveness of the programme was expected to last. RESULTS: In the base case, using only the observed effectiveness of the NHS DPP at 3 years, it was found that the programme is likely to dominate usual care, by generating on average 40.8 incremental QALYs whilst saving £135,755 in costs for a cohort of 1000. At a willingness to pay of £20,000 per QALY, 98.1% of simulations were on or under the willingness-to-pay threshold. Scaling this up to the number of referrals actually received by the NHS DPP prior to April 2020, cost savings of £71.4 million were estimated over the 35-year time horizon and an additional 21,472 QALYs generated. These results are robust to several sensitivity analyses. CONCLUSION: The NHS DPP is likely to be cost-effective. Indeed, in the majority of the simulations, the NHS DPP was cost-saving and generated greater QALYs, dominating usual care. This research should serve as evidence to support the continued investment or recommissioning of diabetes prevention programmes.
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The Diabetes Prevention Program demonstrated cost-effectiveness, but its reliance on in-person coaching and frequent monitoring sessions poses challenges for widespread implementation.
“For example, the Diabetes Prevention Program (DPP) demonstrated costeffectiveness [14,15] but its reliance on in-person coaching and frequent monitoring sessions poses challenges for widespread implementation in resource-constrained healthcare systems like the NHS.”
From Economic evaluation of wearable fitness trackers versus metformin for preventing type 2 diabetes in the UK population (2025) · cites this paper as [14]
The Abstract conclusion finds the English NHS DPP likely to be cost-effective. The Discussion (Main Findings) describes the US DPP’s frequent individual and face-to-face visits and cautions that its trial results may not translate to the NHS programme. It does not conclude that those visits or monitoring pose a barrier to widespread implementation in resource-constrained NHS settings, nor does it evaluate the US DPP’s cost-effectiveness. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIncremental effects from Herman et al. (2005) were used because they have been used in the most recent studies in the UK context.
“Table 6 presents the incremental effects from Herman et al. (2005) as they have been used in the most recent studies in the U.K. context [14,21].”
From Economic evaluation of wearable fitness trackers versus metformin for preventing type 2 diabetes in the UK population (2025) · cites this paper as [14]
Methods > Sensitivity Analyses (page not available) uses US DPP trial data identified as a parameter source in Herman et al. (2005) for an alternative diabetes-transition scenario. It does not say that recent UK studies used Herman’s incremental effects, or provide those effects as such. (LLM, conf=0.79)
Experimental — accuracy not yet measuredUtility scores for normal, prediabetes and T2D patients were sourced from McManus (2024) because the setting and population of that study were highly comparable to this study.
“The utility scores for the normal, prediabetes and T2D patients were sourced from McManus (2024) as the setting and the population of that study was highly comparable to ours (see Table 5).”
From Economic evaluation of wearable fitness trackers versus metformin for preventing type 2 diabetes in the UK population (2025) · cites this paper as McManus (2024)
A four-state model structure was adopted because it has been clinically validated and used in several studies in the UK context.
“We adopted a four-state model structure: normal state (NGT), prediabetes state (PreD)/type 2 diabetes (T2D), and death (D) as it has been clinically validated and used in several studies in the UK context [14,15,21,30].”
From Economic evaluation of wearable fitness trackers versus metformin for preventing type 2 diabetes in the UK population (2025) · cites this paper as [14]
A cycle length of one year was chosen, in line with similar studies in the UK context.
“We chose a cycle length of one year, in line with similar studies in the UK context [14,21].”
From Economic evaluation of wearable fitness trackers versus metformin for preventing type 2 diabetes in the UK population (2025) · cites this paper as [14]
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References 50 · Cited by 10
Research works printed but not linked: 3
- [24]National Institute for Health and Care Excellence. Guide to the methods of technology appraisal. 2013. Available from: https://www.nice.org.uk/process/pmg9/chapter/the-reference-case. 27905712
- [27]Gray AM Applied methods of cost-effectiveness analysis in healthcare 2010 Oxford OUP
- [42]Ashra NB, et al. A systematic review and meta-analysis assessing the effectiveness of pragmatic lifestyle interventions for the prevention of type 2 diabetes mellitus in routine practice. 2015.
- Authors
- McManus, E.
- Affiliations
- University of Manchester (GB)
- Corresponding author
- McManus, Emma
- ORCID
- McManus, Emma
- Venue
- PharmacoEconomics - Open
- Published
- 2024-04-20
- Volume
- 8
- Issue
- 4
- Pages
- 569-583
- ISSN
- 2509-4254 (ISSN-L)
- 2509-4262
- PMC
- PMC11252105
- OpenAlex
- W4394987314
- Cited by
- 10
- References
- 50
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 2
- FWCI
- 3.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PharmacoEconomics - Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, cc-by-nc)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- Health and Social Care Delivery Research (16/48/07)
- 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, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- NHS Diabetes Prevention Programme, diabetes prevention, cost-effectiveness, non-diabetic hyperglycaemia, quality-adjusted life years, Markov model, usual care comparison, health policy decision-making, health system costs
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