International Journal of Technology Assessment in Health Care

ASSESSMENTS

COST EFFECTIVENESS OF PEER SUPPORT FOR TYPE 2 DIABETES

Paddy Gillespiea1, Eamon O'Sheaa2, Gillian Paula3, Tom O'Dowda3 and Susan M. Smitha4

a1 National University of Ireland, Galway email: paddy.gillespie@nuigalway.ie

a2 National University of Ireland, Galway

a3 Trinity College Dublin

a4 Royal College of Surgeons Ireland

Abstract

Objectives: The aim of this study is to examine the cost-effectiveness of a group-based peer support intervention in general practice for patients with type 2 diabetes.

Methods: Incremental cost utility analysis combining within trial and beyond trial components to compare the lifetime costs and benefits of alternative strategies: Control: standardized diabetes care; Intervention: group-based peer support in addition to standardized diabetes care. Within trial analysis was based on a cluster randomized controlled trial of 395 patients with type 2 diabetes in the east of Ireland. Beyond trial analysis was conducted using the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model. Uncertainty was explored using a range of sensitivity analyses and cost-effectiveness acceptability curves were generated.

Results: Compared with the control strategy, the intervention was associated with an increase of 0.09 (95 percent confidence interval [CI], −0.05 to 0.25) in mean quality-adjusted life-years per patient and savings of €637.43 (95 percent CI, −2455.19 to 1125.45) in mean healthcare cost per patient and €623.39 (95 percent CI, −2507.98 to 1298.49) in mean total cost per patient respectively. The likelihood of the intervention being cost-effective was appreciably higher than 80 percent for a range of potential willingness-to-pay cost-effectiveness thresholds.

Conclusions: Our results suggest that while a group-based peer support intervention shows a trend toward improved risk factor management, we found no significant differences in final cost or effectiveness endpoints between intervention and control. The probabilistic results suggest that the intervention was more cost-effective, with probability values of higher than 80 percent across a range of potential cost-effectiveness threshold values.

This study was fully funded by the Health Research Board of Ireland. The study sponsors had no part in the design of the study; the collection, analysis, and interpretation of the data; the writing of the report; and the decision to submit the article for publication. The study was approved by the Research Ethics Committee of the Irish College of General Practitioners. All authors report no potential conflict of interest with regard to this article. Susan M. Smith, Eamon O'Shea, and Tom O'Dowd conceived the study and together with Gillian Paul participated in the design of the trial and intervention. Paddy Gillespie and Eamon O'Shea undertook the acquisition and analysis of the health economic data. All authors, participated in the critical revision of the manuscript, and have seen and approved the final version. We thank the other members of the peer support study team. We thank the peer supporters, patients and the GPs and practice nurses from the following practices: Shandon House, Summerhill, Co. Meath; 110 North Strand, Dublin1; Kilmacud Medical Centre, Stillorgan, Co. Dublin; Rialto Medical Centre, Dublin 8; Riverside Medical Centre, Dublin 15; Chapelizod Meidical Centre, Dublin 20; 19 Ashfield Road, Dublin 22; Main Street, Blessington, Co.Wicklow; Kilcock Medical Centre, Co Kildare; 31 Manor Road, Dublin 20; Whitworth Medical Centre, Dublin 9; Nangor Medical Centre, Dublin 22; Ballymun Health Centre, Dublin 9; Sheehan Medical Centre, Dun Laoire, Co. Dublin; Nobber Health Centre, Co. Meath; 443 Howth Road, Dublin 5; Old Bawn Way, Dublin 24; Springfield Medical Centre, Dublin 24; 632 South Circular Road, Dublin 8; Northgate Surgery, Drogheda, Co.Louth; Castleknock Medical Centre, Dublin 15; Carlton Clinic, Bray, Co. Wicklow.