1. Cost-effectiveness of multicomponent interventions in type 2 diabetes mellitus in a cluster randomised controlled trial: the INDICA study
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Laura Vallejo-Torres, Marta Riaño Ruiz, Yolanda Ramallo-Fariña, Montserrat Carmona, Leticia Rodríguez-Rodríguez, Lidia García-Pérez, Miguel Angel García-Bello, Ana Maria Wägner, Himar Gonzalez-Pacheco, Pedro G Serrano-Aguilar, Abraham Pérez de la Rosa, Alicia Pareja Ríos, Andrés Sifre Perello, Ángela Trinidad Gutiérrez Pérez, Antonio Cabrera de León, Antonio García Quintana, Armando Carrillo Domínguez, Bernardo Eusebio Herrera Domínguez, Carlos Sedeño Pérez, Carlos Ramírez Álamo, Cecilia Lobos Soto, Cristina Padrón Pérez, Dácil Alvarado Martel, Daniel Hernández Obregón, Elsa Espinosa Pozuelo, Elsa Florido Mayor, Engracia Pinilla Domínguez, Fátima Herrera García, Félix Bonilla Aguiar, Francisco Cabrera López, Gregorio Muelas Martín, Ignacio García Puente, Isabel García Calcerrada, Jacqueline Álvarez Pérez, Jorge Federico Aldunate Page, Jose Antonio García Dopico, Juan Andrés Báez Hernández, Julia Charlotte Wiebe, Lilisbeth Perestelo Pérez, Luis Morcillo Herrera, Marcos Estupiñán Ramírez, María Inmaculada González Pérez, María Isabel Visuerte Morales, María Pino Afonso Medina, Marta Tejera Santana, Mercedes Lorenzo Medina, Nayra Pérez Delgado, Pablo Pedrianez Martín, Pilar Peláez Alba, Rafael Valcárcel, Remedios Castro Sánchez, Rodrigo Abreu González, Rosa Borges Trujillo, Víctor Lorenzo Sellarés, Beatriz Santos-Hernández, Carmen Daranas Aguilar, Carolina Guerra Marrero, Dulce N Hernández Correa, Fernando Montón Álvarez, Gloria Guerra de la Torre, Guillermo Monzón, Héctor de la Rosa Merino, Ignacio Llorente Gómez de Segura, Iván Castilla Rodríguez, Juan José Pérez Valencia, Leopoldo Martín, Lluis Serra Majem, Margarita Roldán Ruano, María del Mar Romero Fernández, Mauro Boronat Cortés, Miguel JuanMora García, Pedro de Pablos Velasco, Salvador Acosta González, and Sybille Kaiser Girardot
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Medicine - Abstract
Objective To analyse the cost-effectiveness of multicomponent interventions designed to improve outcomes in type 2 diabetes mellitus (T2DM) in primary care in the Canary Islands, Spain, within the INDICA randomised clinical trial, from the public health system perspective.Design An economic evaluation was conducted for the within-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.Outcomes The main outcome was the incremental cost per quality-adjusted life-years (QALY). Only the intervention and the healthcare costs were included.Analysis Multilevel models were used to estimate results, and to measure the size and significance of incremental changes. Missed values were treated by means of multiple imputations procedure.Results There were no differences between 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). PFI and CBI arms were dominated by the other two arms, PTI and UC. The differences between the PTI and the 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 in the UC arm (€2750, 95% CI €2506 to €2995), but this difference did not reach statistical significance. Base case estimates of the incremental cost per QALY indicate that the PTI strategy was the cost-effective option.Conclusions The INDICA intervention designed for patients with T2DM and families is likely to be cost-effective from the public healthcare perspective. A cost-effectiveness model should explore this in the long term.Trial registration number NCT01657227.
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- 2022
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