BACKGROUND: The DAFNE structured education programme for adults with Type 1 diabetes is traditionally delivered over five consecutive days. However, it is not always convenient for individuals to find the time to attend an intensive fiveday programme due to work and other obligations.
AIM: To provide a preliminary estimate of the cost-effectiveness of Dose Adjustment For Normal Eating (DAFNE) structured education for adults with Type 1 diabetes delivered one day per week over five weeks ('5-week DAFNE') compared with standard DAFNE (five consecutive days; '1-week DAFNE').
RESULTS: The costing analysis based on complete cases from the within-trial data showed that the mean cost per patient during the 12 month trial period was £17.70 higher for the 1-week DAFNE arm than the 5-week DAFNE arm. The 5-week DAFNE arm generated 0.0252 more QALYs per person over the 12 month trial period than the 1-week DAFNE arm, corresponding to 9 days of perfect health per person (based on complete cases). The modelled lifetime cost for the 1-week DAFNE arm was £45,481 and for the 5-week DAFNE arm was £46,262, giving a difference of £781. The modelled lifetime QALYs for the 1-week DAFNE arm were 11.5767 and for the 5-week DAFNE arm were 11.5527, leading to a difference of -0.0240, which corresponds to 8.76 days per person in perfect health.
METHODS: A within-trial cost-effectiveness analyses used patient-level data from a randomised controlled trial (RCT) of 5-week DAFNE versus 1-week DAFNE to estimate the cost-effectiveness of the new intervention over 1 year. A patient-level simulation model of Type 1 diabetes was developed to estimate lifetime costs and quality-adjusted life years (QALYs) from an NHS perspective. The Sheffield Type 1 Diabetes Policy Model uses data from the DAFNE Research Database and published evidence to simulate the incidence of microvascular, macrovascular and acute diabetic complications. Preliminary data from a RCT of 5-week DAFNE versus 1-week DAFNE were used to inform patient characteristics and clinical effectiveness parameters in the model.
CONCLUSIONS: Based on both the within-trial analyses and the long-term model, it has been shown that the mean QALY values between the 1-week DAFNE and 5-week DAFNE arms are very close to each other. Given the limited differences in terms of mean per patient cost between the two arms, the results suggest that both 1-week and 5-week DAFNE methods could be used as policy tools to deliver structured education programmes to patients with Type 1 diabetes by the NHS.
