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Cost-effectiveness of implementing the National Health Service England Diabetes Prevention Programme in Canada: a
Nisha Gupta1, Jonathan Valabhji1, Emma McManus1
1Department of Medicine (Gupta, Rahme, Campbell, Dasgupta), McGill University; Centre for Outcomes Research and Evaluation (Gupta, Campbell, Dasgupta), Research Institute of the McGill University Health Centre, Montréal, Que.; Department of Metabolism, Digestion and Reproduction (Valabhji), Faculty of Medicine, Chelsea and Westminster Hospital Campus, Imperial College London, London, UK; Health Organisation, Policy and Economics (McManus), Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Global and Public Health (Campbell), McGill University, Montréal, Que.
Abstract:
The National Health Service (NHS) England's Diabetes Prevention Programme (DPP) is a cost-effective, publicly funded program of structured dietary and physical activity counselling that has been shown to reduce the incidence of progression from prediabetes to type 2 diabetes. We sought to examine the cost-effectiveness of implementing an NHS England-style DPP in Quebec and Ontario.
Methods:
We compared usual care for people with prediabetes with a DPP using a cohort-state transition Markov model of 4 mutually exclusive health states (normal glucose tolerance, prediabetes, type 2 diabetes, and death) over a 35-year time horizon, run separately for Quebec and Ontario. We sourced transition probabilities, costs, and utilities from Canadian sources, the NHS England DPP, and published literature. We modelled the reduction in progression from prediabetes to type 2 diabetes using effectiveness data from the first 3 years of follow-up from the NHS England DPP. We adopted a health care system perspective and used a 1.5% annual discount rate. We presented costs in 2025 Canadian dollars and effectiveness in quality-adjusted life-years (QALYs). We generated base-case results using probabilistic analysis with 10 000 simulations.
Results:
The mean total costs of the DPP strategy were $101 833 per participant in Quebec and $101 835 in Ontario, compared with $102 077 for usual care, yielding incremental cost savings of $244 per participant in Quebec and $242 in Ontario. The 95% uncertainty range (UR) for incremental costs was -$1017 to $405 in Quebec and -$1016 to $408 in Ontario. The DPP generated a mean gain of 0.060 QALYs per participant (95% UR 0.024 to 0.094). It was less costly and more effective than usual care in 74.8% of simulations in Quebec and 74.7% in Ontario. Sensitivity analyses confirmed robustness to parameter uncertainty.
Interpretation:
An NHS England-style DPP would be cost-effective in Ontario and Quebec. Our findings support the potential value of investing in DPPs in Canada and highlight an opportunity to reduce the burden of type 2 diabetes.
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