Modelling the potential cost-effectiveness of a targeted follow-up intervention to improve glycaemic response following structured training in flexible intensive insulin therapy
J Kruger, A Brennan, P Thokala, H Basarir, D Cooke, M Clark, R Bond, S R Heller
Objective: To use statistical and health economic simulation modelling to estimate the cost-effectiveness of a hypothetical follow-up intervention targeted at people who have undertaken structured training in flexible intensive insulin therapy, based on their initial psychosocial response.
Research Design and Methods: Data from a psychosocial study of 262 people with type 1 diabetes who received structured education in flexible intensive insulin management were used. Multiple linear regression was used to predict HbA1c response following structured education (absolute change in HbA1c from baseline to 12 months) from initial psychosocial response to structured education (change in psychological questionnaire scores from baseline to 3 months). The Sheffield Type 1 Diabetes Policy Model was used to estimate the cost-effectiveness of a follow-up intervention targeted at people not predicted to achieve glycaemic targets from the statistical regression equation.
Results: Initial increases in fear of hypoglycaemia, initial increases in diabetes knowledge, higher baseline body mass index and male gender were found to be predictive of HbA1c outcome after structured education. The simulation modelling suggested that a follow-up intervention targeted based on the regression equations and costing the same as or double a standard five-day structured education program would be cost-effective if it could generate a sustained HbA1c improvement of 0.25-0.5%.
Conclusions: Further research into the design and development of a targeted follow-up intervention would be beneficial as such an intervention may offer a cost-effective method of improving glycaemic outcomes in those patients not achieving glycaemic targets following structured education.