Evidence map›Paper›PMID 25661661›Full record

Trial reportDiabetic medicine : a journal of the British Diabetic Association2015

Cost-effectiveness of intensive multifactorial treatment compared with routine care for individuals with screen-detected Type 2 diabetes: analysis of the ADDITION-UK cluster-randomized controlled trial.

L Tao, E C F Wilson, N J Wareham, A Sandbaek, G E H M Rutten, T Lauritzen, K Khunti, M J Davies, K Borch-Johnsen, S J Griffin and 1 more

Abstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Diabetic medicine : a journal of the British Diabetic Association, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Trial
  4. Article
  5. Article
  6. Review
  7. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

L TaoMRC Epidemiology Unit, University of Cambridge, Norwich, UK.
E C F WilsonCambridge Centre for Health Services Research, University of Cambridge, Norwich, UK.
N J WarehamMRC Epidemiology Unit, University of Cambridge, Norwich, UK.
A SandbaekDepartment of Public Health, Section of General Practice, University of Aarhus, Denmark.
G E H M RuttenJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
T LauritzenDepartment of Public Health, Section of General Practice, University of Aarhus, Denmark.
K KhuntiDiabetes Research Centre, University of Leicester, UK.
M J DaviesDiabetes Research Centre, University of Leicester, UK.
K Borch-JohnsenDepartment of Public Health, Section of General Practice, University of Aarhus, Denmark.
S J GriffinMRC Epidemiology Unit, University of Cambridge, Norwich, UK.
R K SimmonsMRC Epidemiology Unit, University of Cambridge, Norwich, UK.

Funding

Chief Scientist Office RP-PG-0606-1259Department of Health 08/116/300Department of Health RP-PG-0606-1259Medical Research Council G0001164Medical Research Council MC_U106179471Medical Research Council MC_U106179474Medical Research Council MC_UU_12015/1Medical Research Council MC_UU_12015/4Wellcome Trust 061895Wellcome Trust G061895
6 · The paper itself

Abstract

aimsTo examine the short- and long-term cost-effectiveness of intensive multifactorial treatment compared with routine care among people with screen-detected Type 2 diabetes.

methodsCost-utility analysis in ADDITION-UK, a cluster-randomized controlled trial of early intensive treatment in people with screen-detected diabetes in 69 UK general practices. Unit treatment costs and utility decrement data were taken from published literature. Accumulated costs and quality-adjusted life years (QALYs) were calculated using ADDITION-UK data from 1 to 5 years (short-term analysis, n = 1024); trial data were extrapolated to 30 years using the UKPDS outcomes model (version 1.3) (long-term analysis; n = 999). All costs were transformed to the UK 2009/10 price level.

resultsAdjusted incremental costs to the NHS were £285, £935, £1190 and £1745 over a 1-, 5-, 10- and 30-year time horizon, respectively (discounted at 3.5%). Adjusted incremental QALYs were 0.0000, - 0.0040, 0.0140 and 0.0465 over the same time horizons. Point estimate incremental cost-effectiveness ratios (ICERs) suggested that the intervention was not cost-effective although the ratio improved over time: the ICER over 10 years was £82,250, falling to £37,500 over 30 years. The ICER fell below £30 000 only when the intervention cost was below £631 per patient: we estimated the cost at £981.

conclusionGiven conventional thresholds of cost-effectiveness, the intensive treatment delivered in ADDITION was not cost-effective compared with routine care for individuals with screen-detected diabetes in the UK. The intervention may be cost-effective if it can be delivered at reduced cost.

Indexed as

Patient-Centered CareAgedCluster AnalysisCohort StudiesCombined Modality TherapyCost-Benefit AnalysisDiabetes ComplicationsDiabetes Mellitus, Type 2FemaleHealth Care CostsHumansIncidenceMaleMass ScreeningMiddle AgedPatient Education as Topic

Identifiers

PMID25661661
PMCPMC4510785

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.