Weight loss, diabetes remission lead to cost savings over lifetime
Participants in the Diabetes Remission Clinical Trial’s counter-weight plus intervention had a higher diabetes remission rate and were projected to have lower lifetime health care costs compared with controls, according to study data.
“It is most unusual to be able to provide a new medical treatment for a major chronic disease which is both health improving and cost-saving,” Michael E. J. Lean, MD, FRCP, FRCPS, a clinical senior research fellow and honorary consultant in human nutrition in the School of Medicine, Dentistry and Nursing at the University of Glasgow, U.K., and colleagues wrote in a study published in Diabetologia. “The Diabetes Remission Clinical Trial (DiRECT) study has shown that durable remissions of type 2 diabetes to a nondiabetic state can be achieved through an integrated weight-management program. ... The present analysis indicates that the intervention is likely to generate quality-adjusted life-year gains and be not only cost-effective, but also cost-saving after 5 to 6 years.”
Researchers conducted an analysis of intervention and routine costs with all participants in the counterweight-plus intervention in DiRECT. Intervention costs included training, monitoring appointments with providers, program materials and sachets of low-energy formula diet. Details on medications and routine medical care were gathered from general practitioner records. Researchers also estimated lifetime cost-effectiveness by predicting time to relapse among participants who had been in remission for 2 years. Cost-analysis figures from 149 DiRECT participants were compared with a matching control group that received standard of care treatment. All cost figures were listed in 2018 British pounds.
Individuals in the DiRECT intervention group had higher mean 2-year total health care costs during their participation in the program when compared with the control group (mean difference, 616 British pounds; 95% CI, –45 to 1,269). Mean intervention costs amounted to 1,411 British pounds, with the formula diet and practice visits making up most of the costs (mean costs, 1,364 British pounds; 95% CI, 1,260-1,464). DiRECT participants had an estimated mean savings of about 796 British pounds from lower medication use and fewer routine health visits during the 2-year period when compared with the control group. Although there was negligible nonintervention cost savings between the two groups in year 1, the second year of the study yielded a mean savings in nonintervention costs of 521 British pounds (95% CI, 12-1,085).
The DiRECT intervention group had more individuals reach diabetes remission over 2 years (35.6% vs. 3.4%) and added more QALYs (11.27 vs. 11.22) when compared with the control group. The study’s model predicted the intervention group would save 1,337 British pounds (95% CI, 674-2,081) over a lifetime compared with standard of care and overall cost savings would be reached after 5 to 6 years.
“Relapse into diabetes, driven by weight regain, incurs costs from relapse management and from resumption of progressive costs for diabetes and its complications,” the researchers wrote. “Though relapse had a bearing on outcomes in our study, even relatively rapid relapse did not alter the conclusion that the low-energy diet intervention was capable of producing long-term health gains without adding long-term costs. The counterweight-plus intervention may, therefore, be expected to be transferable to other diabetes care settings in a similarly cost-effective manner.”