Evaluating the Long-Term Cost-Effectiveness of the English NHS Diabetes Prevention Programme using a Markov Model

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 pound 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 pound in costs for a cohort of 1000. At a willingness to pay of 20,000 pound 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 pound 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.