The cost-effectiveness of the Dose Adjustment for Normal Eating (DAFNE) structured education programme: an update using the Sheffield Type 1 Diabetes Policy Model

AimsTo estimate the cost-effectiveness of training in flexible intensive insulin therapy [as provided in the Dose Adjustment for Normal Eating (DAFNE) structured education programme] compared with no training for adults with Type1 diabetes mellitus in the UK using the Sheffield Type1 Diabetes Policy Model. MethodsThe Sheffield Type1 Diabetes Policy Model was used to simulate the development of long-term microvascular and macrovascular diabetes-related complications and the occurrence of diabetes-related adverse events in 5000 adults with Type1 diabetes. Total costs and quality-adjusted life years were estimated from a National Health Service perspective over a lifetime horizon, discounted at a rate of 3.5%. The treatment effectiveness of DAFNE was modelled as a reduction in HbA(1c) that affected the risk of developing long-term diabetes-related complications. Probabilistic and structural sensitivity analyses were conducted. ResultsDAFNE resulted in greater life expectancy and reduced incidence of some diabetes-related complications compared with no DAFNE. DAFNE was found to generate an average of 0.0294 additional quality-adjusted life years for an additional cost of 426 per patient, leading to an incremental cost-effectiveness ratio of 14400 compared with no DAFNE. There was a 54% probability that DAFNE would be cost-effective at a willingness-to-pay threshold of 20000 per quality-adjusted life year. ConclusionsThe results of this study suggest that DAFNE is a cost-effective structured education programme for people with Type1 diabetes and support its provision by the National Health Service in the UK.