Economic Evaluation of NHS England's Type 2 Diabetes Path to Remission Pilot Scheme: Evidence From Real-World Data...

The 'Type 2 Diabetes Path to Remission' programme (T2DPR) of NHS England (NHSE) is a low-calorie diet intervention with behavioural support for adults with a recent type 2 diabetes mellitus (T2D) diagnosis and body mass index (BMI) > 25 kg/m² (> 27 kg/m² if White). The DiRECT trial, involving a similar intervention, showed the intervention cost per additional case of remission after 1 year exceeded £2000, and £20,000 after 5 years. However, it remains unclear whether this represents value for money for NHSE, whether comparable outcomes would be achieved in routine care settings or what the associated costs are from the service user perspective.

The aim of this study was to conduct an economic evaluation of the T2DPR pilot programme from the perspectives of NHSE and of service users, and the budget impact of a nationwide rollout of the programme to all eligible adults.

Real-world clinical data from T2DPR pilot programmes were linked to National Diabetes Audit (NDA) datasets (n = 838). A cost-utility analysis with a lifetime time horizon was conducted from the NHSE perspective using the UKPDS Outcomes Model v.2.2, which predicted quality-adjusted life years (QALYs) and healthcare costs based on data collected pre-referral and at 12 months. A counterfactual scenario without the intervention was modelled using pre-referral data only. Assumptions on weight regain and HbA1c trajectories beyond 24 months were tested in sensitivity analyses. National T2D incidence and obesity prevalence data informed estimates of eligible adults for nationwide rollout and projected budget impact. Questionnaire data on service user out-of-pocket expenses provided indicative financial costs from the user perspective.

The T2DPR pilot is estimated to be cost effective at a £20,000 per quality-adjusted life-year threshold, provided weight and HbA1c levels remain lower than in a counterfactual scenario for at least 6-7 years (£19,759.80/QALY assuming 7 years). Given that an estimated 50,000 adults would be eligible annually if rolled out nationwide, a 10% uptake would cost NHSE approximately £6.1 million per year, while uptake of around one-third of eligible adults would exceed £20 million. Some service users reported additional out-of-pocket expenses, primarily from trying different product flavours and continued consumption of products beyond the duration specified in the scheme. These expenses are likely partially offset by savings on overall grocery expenses.

A nationwide rollout of T2DPR would have significant implications for healthcare budgets and opportunity costs, given potentially high demand driven by the high incidence of T2D among eligible adults. Cost effectiveness depends on the weight and HbA1c regain experienced by service users after discharge. Future research should explore these outcomes, including potential inequalities in regain trajectories.