Cost effectiveness of group follow-up after structured education for type 1 diabetes: a cluster randomised controlled trial

Background: This study examines the cost effectiveness of group follow-up after participation in the Dose Adjustment for Normal Eating (DAFNE) structured education programme for type 1 diabetes. Methods: Economic evaluation conducted alongside a cluster randomised controlled trial involving 437 adults with type 1 diabetes in Ireland. Group follow-up involved two group education 'booster' sessions post-DAFNE. Individual follow-up involved two standard one-to-one hospital clinic visits. Incremental costs, quality-adjusted life years (QALYs) gained and cost effectiveness were estimated at 18 months. Uncertainty was explored using sensitivity analysis and by estimating cost effectiveness acceptability curves. Results: Group follow-up was associated with a mean reduction in QALYs gained of 0.04 per patient (P value, 0.052; 95% CI, -0.08 to 0.01, intra-class correlation (ICC), 0.033) and a mean reduction in total healthcare costs of is an element of 772 (P value, 0.020; 95% CI, -1,415 to -128: ICC, 0.016) per patient. At alternative threshold values of is an element of 5,000, is an element of 15,000, is an element of 25,000, is an element of 35,000, and is an element of 45,000, the probability of group follow-up being cost effective was estimated to be 1.000, 0.762, 0.204, 0.078, and 0.033 respectively. Conclusions: The results do not support implementation of group follow-up as the sole means of follow-up post-DAFNE. Given the reported cost savings, future studies should explore the cost effectiveness of alternative models of group care for diabetes.