£1000: the cost of delivering a Type 2 diabetes remission programme in the NHS
A new study suggests rolling out a Type 2 diabetes remission programme in the NHS could cost around £1,067 per participant in its first year – or, factoring in the likelihood of success, £2,564 for each case of remission. Researchers say findings ‘make the case for shifting resources to offer remission’ in the future.
The economic analysis, published today in the Lancet Diabetes and Endocrinology, was carried out by researchers at the University of Glasgow, using data from the Diabetes UK-funded Diabetes Remission Clinical Trial (DiRECT). The trial is led by Professors Mike Lean at University of Glasgow and Roy Taylor at Newcastle University.
The team compared the treatment costs of the two groups in DiRECT: those on the weight loss programme (the intervention group), and those receiving current standard NHS care (the control group).
They took into account the cost of healthcare professional training, providing the low-calorie formula diet, review appointments with healthcare professionals and supporting literature. The team also factored in the costs of any routine health care during the 12 months, including primary care, community care, hospitalisations, and anti-diabetes and anti-hypertensive medications.
The cost of the 12-month programme, allowing for savings for reduced drug and medical needs, was £1,067.
By the end of the first 12 months of the DiRECT study, 46% of participants were in remission. Taking this likelihood of achieving remission into account, the team estimated that each case of remission would cost £2,564.
The most recent, comprehensive analysis in 2010 , cited the cost of treating and managing Type 2 diabetes across the whole UK population – coincidentally – at £2,564. Allowing for inflation, this cost rises to £2801. However, the average annual cost of delivering care through the NHS does include the treatment of serious complications, and covers all stages of Type 2 diabetes throughout a person’s lifetime, which this new analysis does not.
The DiRECT remission programme, delivered within NHS primary care, is therefore relatively inexpensive when compared to the serious and expensive complications of Type 2 diabetes, which remission might avoid. As we continue the study we will learn more about the balance of financial costs and benefits for this approach.
These findings support the case for considering weight reduction interventions as a compelling option for some people to put their Type 2 diabetes into remission.
Professor Andrew Briggs, Health Economist at the University of Glasgow, explains:
“This intervention is relatively inexpensive when compared to managing Type 2 diabetes, and we anticipate that there will be cost-savings further down the line. If people can stay in remission and therefore reduce their chances of developing diabetes complications, the cost savings to the NHS could be substantial.
“We can’t know this for certain yet. Which is why the long-term follow-up of these participants – alongside those accessing any NHS remission pilots in the near future – is very important. However, these findings are encouraging, and – in our view – begin to make the case for shifting resources to offer remission-based models of care in the future.”
DiRECT is testing a low-calorie weight management programme in over 300 people across Glasgow and Tyneside. The programme, which involves an 800 calorie liquid diet and structured, long-term support from a healthcare professional to reintroduce healthy food and maintain the weight loss, is aiming to establish if the approach could put people with Type 2 diabetes into remission and keep them there in the longer term.
Given the enormous international interest in the first year results of DiRECT, the team wanted to understand the economic implications of delivering a programme like DiRECT within routine NHS care.
Dr Elizabeth Robertson is Director of Research at Diabetes UK. She said: “It is critical that we understand the real world costs of new, promising, remission interventions like DiRECT. The second-year results of the DiRECT study are eagerly anticipated, as the case for remission-centred Type 2 diabetes care as an option for some individuals depends upon a thorough understanding of the longer-term benefits.
“If people can remain in remission, and therefore reduce their risk of developing serious diabetes-related complications in the future, the cost savings to the NHS could be significant. Costs aside, remission from Type 2 – and the possibility of living free of the condition – has to be the preferred option for people and clinicians alike.”
Bridget Turner is Director of Policy and Campaigns at Diabetes UK. She said: “The first year results of DiRECT were very encouraging and, while we don’t yet have all the answers, this economic study, and its findings, are particularly timely.
“We’re delighted that, thanks to a growing body of evidence – including that from DiRECT – NHS England and Scotland have committed to exploring the potential of intensive lifestyle interventions as an option which may lead to remission for more people with Type 2 diabetes near to diagnosis.
“We hope this economic analysis will help to inform the set up and delivery of more pilots – with appropriate monitoring, follow up and support – in the future.”
Mike Lean, Professor of Human Nutrition at the University of Glasgow and consultant physician at Glasgow Royal Infirmary, adds: “The cost of a year’s programme to achieve remission of Type 2 diabetes is less than the annual cost of continuing to treat this progressive and often debilitating condition – particularly at its later stages. It is becoming hard to see why, ethically, people with Type 2 diabetes should not be offered the chance, and supported, to achieve remission if they can. This is no quick fix, but instead a promising medical treatment with potentially huge benefits.”
The Scottish government recently published its A Healthier Future framework, in which £42 million has been dedicated to the prevention, early detection and early intervention of Type 2 diabetes through improved provision of weight management services. NHS Boards around Scotland can use this funding to deliver programmes to prevent Type 2 diabetes and put it into remission.
NHS England also recently committed to piloting a remission programme for 5,000 people with Type 2 diabetes in 2019, which Diabetes UK welcomed.
To date, Diabetes UK has committed £2.8 million to DiRECT.
First published: 21 December 2018