Cost-Effectiveness of Multicomponent Interventions in Type 2 Diabetes Mellitus in a Cluster-Randomized Controlled Trial: The INDICA Study

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BMJ open. 2022 Apr 8;12(4):e058049. doi: 10.1136/bmjopen-2021-058049.

ABSTRACT

OBJECTIVE: To analyze the cost-effectiveness of multicomponent interventions designed to improve type 2 diabetes mellitus (T2DM) outcomes in primary care in the Canary Islands, Spain, within the INDICA randomized clinical trial, the perspective of the public health system.

DESIGN: An economic evaluation was conducted for the intra-trial period (2 years) comparing the four arms of the INDICA study.

SETTING: Primary care in the Canary Islands, Spain.

PARTICIPANTS: 2334 patients with T2DM without complications were included.

INTERVENTIONS: Interventions for patients (PTI), for primary care professionals (PFI), for both (combined intervention arm for patients and professionals, CBI) and usual care (UC) as a control group .

RESULTS: The primary outcome measure was incremental cost per quality-adjusted life-year (QALY). Only intervention and health costs were included.

DISCUSSION: Multilevel models were used to estimate outcomes and to measure the magnitude and significance of incremental changes. Missing values ​​were handled using a multiple imputation procedure.

RESULTS: There were no differences between the arms in terms of costs (p = 0.093), while some differences were observed in terms of QALYs after 2 years of follow-up (p = 0.028). The PFI and CBI arms were dominated by the other two arms, PTI and UC. The differences between the PTI and UC arms were very small in terms of QALYs, but significant in terms of healthcare costs (p = 0.045). The total cost of the PTI arm (€2571, 95% CI €2317 to €2826) was lower than the cost of the CU arm (€2750, 95% CI €2506 to €2995), but this difference did not reach significance. The base case estimates of the incremental cost per QALY indicate that the PTI strategy was the most cost-effective option.

CONCLUSIONS: The INDICA intervention designed for patients with T2D and their families is likely to be cost-effective from a public health care perspective. A cost-effectiveness model should explore this over the long term.

TEST REGISTRATION NUMBER: NCT01657227.

PMID:35396305 | DOI:10.1136/bmjopen-2021-058049

Sara H. Byrd