Early economic evaluation of an intervention to improve uptake of the NHS England Diabetes Prevention Programme
Open accessAbstract
BACKGROUND: Despite reported increases in referral numbers, a large proportion of those with prediabetes still decline participation in the NHS England Diabetes Prevention Programme (NDPP). The aim of this study was to explore whether investment in interventions to improve uptake of the programme has the potential to be cost-effective. METHODS: An early cost-utility analysis was conducted using a Markov model parameterized based on secondary data sources. We explored different uptake scenarios and the impact that this had on the maximum allowable intervention price based on cost-effectiveness at the UK NICE willingness to pay threshold of £20,000 (US$ 25,913). Value of information analyses were conducted to explore the potential value of further research to resolve uncertainty at each uptake level. RESULTS: As uptake levels increase, the maximum allowable intervention price and overall expected value of removing decision uncertainty increases. For 5 percentage and 50 percentage points increase in uptake levels, the maximum allowable intervention price is £41.86 (US$ 54.23) and £418.59 (US$ 542.34) per person, and the overall expected value of removing decision uncertainty are £361,818,839 (US$ 468,786,625) and £1,468,712,316 (US$ 1,902,921,063) respectively. CONCLUSION: There is headroom for investment in interventions that improve uptake to the NDPP, thereby allowing the programme itself to be delivered in a manner that remains cost-effective.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
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 [15]
The Introduction describes the NHS programme as involving face-to-face sessions over at least nine months and reports low uptake and unmet participation targets. The Conclusion discusses how the NHS programme could remain cost-effective with an intervention to improve uptake. Neither passage establishes that the US DPP’s frequent monitoring sessions hinder widespread implementation in the NHS, and the paper’s economic evaluation concerns improving uptake of the NHS programme rather than demonstrating the US DPP’s cost-effectiveness. (LLM, conf=0.83)
Experimental — accuracy not yet measuredA 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 [15]
The Methods and Model Description sections describe the four states—normoglycaemia, prediabetes, type 2 diabetes, and death—in this NHS England evaluation. Methods also refers to previous model-based evaluations, but our copy does not say the structure was clinically validated or establish that several UK studies used it. No page number is available in the indexed passages. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
(2002) · New England Journal of Medicine · doi:10.1056/nejmoa012512 · Cited by 19,011 · see citing works
Tuomilehto, J., Lindström, J., Eriksson, J. G., Valle, T. T., Hämäläinen, H., Ilanne-Parikka, P., Keinänen-Kiukaanniemi, S., Laakso, M., Louheranta, A., Rastas, M., et al. (2001) · New England Journal of Medicine · doi:10.1056/nejm200105033441801 · Cited by 10,873 · cited 1× · see citing works
“The NDPP was informed by proven Diabetes Prevention Programme models such as the United States Diabetes Prevention Programme (US DPP) [13,14] and the Finnish Diabetes Prevention Programme [15,16].”
MethodThe National Institute for Clinical Excellence
(2001) · Nursing Management · doi:10.7748/nm.8.2.39.s15 · Cited by 3,868 · 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
Diabetes Prevention Program Research Group (2009) · The Lancet · doi:10.1016/s0140-6736(09)61457-4 · Cited by 3,020 · see citing works
Lindström, J., Ilanne-Parikka, P., Peltonen, M., Aunola, S., Eriksson, J. G., Hemiö, K., Hämäläinen, H., Härkönen, P., Keinänen-Kiukaanniemi, S., Laakso, M., et al. (2006) · The Lancet · doi:10.1016/s0140-6736(06)69701-8 · Cited by 1,799 · see citing works
Briggs, A. H., Weinstein, M. C., Fenwick, E. A. L., Karnon, J., Sculpher, M. J., & Paltiel, A. D. (2012) · Medical Decision Making · doi:10.1177/0272989x12458348 · Cited by 887 · 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
Herman, W. H., Hoerger, T. J., Brandle, M., Hicks, K., Sorensen, S., Zhang, P., Hamman, R. F., Ackermann, R. T., Engelgau, M. M., Ratner, R. E., et al. (2005) · Annals of Internal Medicine · doi:10.7326/0003-4819-142-5-200503010-00007 · Cited by 703 · see citing works
Balk, E. M., Earley, A., Raman, G., Avendano, E. A., Pittas, A. G., & Remington, P. L. (2015) · Annals of Internal Medicine · doi:10.7326/m15-0452 · Cited by 371 · see citing works
Applied Methods of Cost-effectiveness Analysis in HealthcarePreprint
Gray, A. M., Clarke, P., Wolstenholme, J. L., & Wordsworth, S. (2010) · RePEc: Research Papers in Economics · Cited by 343 · see citing works
Meigs, J. B., Muller, D. C., Nathan, D. M., Blake, D. R., & Andres, R. (2003) · Diabetes · doi:10.2337/diabetes.52.6.1475 · Cited by 339 · see citing works
A systematic review of real-world diabetes prevention programs: learnings from the last 15 years
Aziz, Z., Absetz, P., Oldroyd, J. C., Pronk, N. P., & Oldenburg, B. F. (2015) · Implementation Science · doi:10.1186/s13012-015-0354-6 · Cited by 306 · see citing works
Gillies, C. L., Lambert, P. C., Abrams, K. R., Sutton, A. J., Cooper, N. J., Hsu, R. T., Davies, M. J., & Khunti, K. K. (2008) · BMJ · doi:10.1136/bmj.39545.585289.25 · Cited by 290 · see citing works
Strong, M., Oakley, J. E., & Brennan, A. (2013) · Medical Decision Making · doi:10.1177/0272989x13505910 · Cited by 248 · see citing works
Morris, D. H., Khunti, K., Achana, F., Srinivasan, B., Gray, L. J., Davies, M. J., & Webb, D. (2013) · Diabetologia · doi:10.1007/s00125-013-2902-4 · Cited by 229 · 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
Roberts, S. A., Barry, E., Craig, D., Airoldi, M., Bevan, G., & Greenhalgh, T. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-017184 · Cited by 124 · see citing works
Barron, E., Clark, R., Hewings, R., Smith, J. A. E., & Valabhji, J. (2017) · Diabetic Medicine · doi:10.1111/dme.13562 · Cited by 81 · see citing works
Penn, L., Rodrigues, A., Haste, A., Marques, M. M., Budig, K., Sainsbury, K., Bell, R., Araújo‐Soares, V., White, M. J., Summerbell, C. D., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-019467 · Cited by 78 · see citing works
Herman, W. H. (2015) · Clinical Diabetes and Endocrinology · doi:10.1186/s40842-015-0009-1 · Cited by 73 · see citing works
Implementing a national diabetes prevention programme in England: lessons learned
Stokes, J., Gellatly, J. L., Bower, P., Meacock, R., Cotterill, S., Sutton, M., & Wilson, P. M. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4809-3 · Cited by 63 · see citing works
Howarth, E., Bower, P., Kontopantelis, E., Soiland‐Reyes, C., Meacock, R., William, W., & Cotterill, S. (2020) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2020-001835 · Cited by 61 · see citing works
Palmer, A. J., & Tucker, D. M. D. (2011) · Primary care diabetes · doi:10.1016/j.pcd.2011.10.006 · Cited by 53 · 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
Neumann, A., Schoffer, O., Norström, F., Norberg, M., Klug, S. J., & Lindholm, L. H. (2014) · Health and Quality of Life Outcomes · doi:10.1186/s12955-014-0150-z · Cited by 42 · see citing works
Thomas, C., Sadler, S., Breeze, P. R., Squires, H., Gillett, M., & Brennan, A. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-014953 · Cited by 42 · see citing works
Shankleman, J., Massat, N. J., Khagram, L., Ariyanayagam, S., Garner, A., Khatoon, S., Rainbow, S. J., Rangrez, S., Colorado, Z., Hu, W., et al. (2014) · British Journal of Cancer · doi:10.1038/bjc.2014.363 · Cited by 40 · see citing works
Neumann, A., Schwarz, P. E. H., & Lindholm, L. H. (2011) · Cost Effectiveness and Resource Allocation · doi:10.1186/1478-7547-9-17 · Cited by 36 · see citing works
Abel, L., Shinkins, B., Smith, A. F., et al. (2019) · Medical Decision Making · doi:10.1177/0272989x19866415 · Cited by 36 · see citing works
Self-citationRodrigues, A., Haste, A., Penn, L., Bell, R., Summerbell, C., White, M. J., Adamson, A., & Sniehotta, F. F. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-05160-2 · Cited by 34 · see citing works
Faria, R., Walker, S., Whyte, S., Dixon, S., Palmer, S., & Sculpher, M. (2016) · Medical Decision Making · doi:10.1177/0272989x16645577 · Cited by 31 · see citing works
Medical Care Costs One Year After Identification of Hyperglycemia Below the Threshold for Diabetes
Nichols, G. A., Arondekar, B. V., & Herman, W. H. (2008) · Medical Care · doi:10.1097/mlr.0b013e31815b9772 · Cited by 27 · see citing works
Thompson, B., Thompson, L. A., Andersen, M. R., et al. (2002) · Preventive Medicine · doi:10.1006/pmed.2002.1046 · Cited by 20 · see citing works
Sutton, A. J., Lamont, J. V., Evans, R., et al. (2018) · PLoS ONE · doi:10.1371/journal.pone.0202796 · Cited by 20 · see citing works
Increasing the uptake of cervical screening programmes
Gannon, M., & Dowling, M. (2008) · British Journal of Nursing · doi:10.12968/bjon.2008.17.20.31642 · Cited by 17 · see citing works
Tsiachristas, A., Gittins, M., Kitchener, H. C., et al. (2017) · Journal of Medical Screening · doi:10.1177/0969141317704679 · Cited by 17 · see citing works
Leal, J., Reed, S., Patel, R. A., Rivero‐Arias, O., Li, Y., Schulman, K. A., Califf, R. M., Holman, R. R., & Gray, A. M. (2020) · Diabetes Care · doi:10.2337/dc20-0717 · Cited by 10 · see citing works
Nelson, R. (2015) · Cited by 9 · see citing works
Bächle, C., Claessen, H., Andrich, S., Brüne, M., Dintsios, C., Slomiany, U., Roggenbuck, U., Jöckel, K., Moebus, S., & Icks, A. (2016) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2015-000172 · Cited by 9 · see citing works
Hinde, S., Horsfield, L., Bojke, L., et al. (2019) · Applied Health Economics and Health Policy · doi:10.1007/s40258-019-00538-8 · Cited by 9 · see citing works
Frempong, S. N., Sutton, A. J., Davenport, C. F., & Barton, P. M. (2019) · PharmacoEconomics - Open · doi:10.1007/s41669-019-0159-7 · Cited by 8 · see citing works
Self-citationImpact of Demographic Changes on Healthcare Expenditures and Funding in the EU
Gandjour, A., Greb, J., Bomsdorf, E., et al. (2005) · Applied Health Economics and Health Policy · doi:10.2165/00148365-200504010-00001 · Cited by 5 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Ashra NB, Spong R, Carter P, 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. London: Public Health England; 2015 Aug.
Cited by
Sorted by citations
McManus, E. (2024) · PharmacoEconomics - Open · doi:10.1007/s41669-024-00487-6 · Cited by 10 · see citing works
Xu, Y., & García-Lorenzo, B. (2025) · BMC Digital Health · doi:10.1186/s44247-025-00194-0
- Authors
- Frempong, S. N., Shinkins, B., Howdon, D., Messenger, M., Neal, R. D., & Sagoo, G. S.
- Affiliations
- University of Leeds (GB)
- Cancer Research UK (GB)
- Corresponding author
- Frempong, Samuel N
- ORCID
- Venue
- Expert Review of Pharmacoeconomics & Outcomes Research
- Publisher
- Informa UK Limited
- Published
- 2021-03-12
- Volume
- 22
- Issue
- 3
- Pages
- 417-427
- ISSN
- 1473-7167 (ISSN-L)
- 1744-8379
- OpenAlex
- W3135022392
- Cited by
- 5
- References
- 43
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 1 · 2022: 1
- FWCI
- 0.57
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Expert Review of Pharmacoeconomics & Outcomes Research (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Figshare (submittedVersion, cc-by)
- Figshare (cc-by)
- Funders
- SomaLogic Inc (116466)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- prediabetes, diabetes prevention, program uptake, cost-effectiveness, value of information, willingness-to-pay threshold, Markov model
- MeSH terms
- Cost-Benefit Analysis, Diabetes Mellitus, Type 2, England, Humans, State Medicine, Quality-Adjusted Life Years
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
