Cost-effectiveness of multicomponent interventions in type 2 diabetes mellitus in a cluster randomised controlled trial: the INDICA study

Lidia García-Pérez, Yolanda Ramallo-Fariña, Laura Vallejo-Torres, Leticia Rodríguez-Rodríguez, Himar González-Pacheco, Beatriz Santos-Hernández, Miguel Angel García-Bello, Ana María Wägner, Montserrat Carmona, Pedro G Serrano-Aguilar, INDICA team, 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, Carmen Daranas Aguilar, Carolina Guerra Marrero, Cecilia Lobos Soto, Cristina Padrón Pérez, Dácil Alvarado Martel, Daniel Hernández Obregón, Dulce N Hernández Correa, Elsa Espinosa Pozuelo, Elsa Florido Mayor, Engracia Pinilla Domínguez, Fátima Herrera García, Félix Bonilla Aguiar, Fernando Montón Álvarez, Francisco Cabrera López, Gloria Guerra de la Torre, Gregorio Muelas Martín, Guillermo Monzón, Héctor de la Rosa Merino, Ignacio García Puente, Ignacio Llorente Gómez de Segura, Isabel García Calcerrada, Iván Castilla Rodríguez, Jacqueline Álvarez Pérez, Jorge Federico Aldunate Page, Jose Antonio García Dopico, Juan Andrés Báez Hernández, Juan José Pérez Valencia, Julia Charlotte Wiebe, Lilisbeth Perestelo Pérez, Leopoldo Martín, Lluis Serra Majem, Luis Morcillo Herrera, Marcos Estupiñán Ramírez, Margarita Roldán Ruano, María Del Mar Romero Fernández, María Inmaculada González Pérez, María Isabel Visuerte Morales, María Pino Afonso Medina, Marta Riaño Ruiz, Marta Tejera Santana, Mauro Boronat Cortés, Mercedes Lorenzo Medina, Miguel JuanMora García, Nayra Pérez Delgado, Pablo Pedrianez Martín, Pedro de Pablos Velasco, Pilar Peláez Alba, Rafael Valcárcel, Remedios Castro Sánchez, Rodrigo Abreu González, Rosa Borges Trujillo, Salvador Acosta González, Sybille Kaiser Girardot, Víctor Lorenzo Sellarés, Lidia García-Pérez, Yolanda Ramallo-Fariña, Laura Vallejo-Torres, Leticia Rodríguez-Rodríguez, Himar González-Pacheco, Beatriz Santos-Hernández, Miguel Angel García-Bello, Ana María Wägner, Montserrat Carmona, Pedro G Serrano-Aguilar, INDICA team, 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, Carmen Daranas Aguilar, Carolina Guerra Marrero, Cecilia Lobos Soto, Cristina Padrón Pérez, Dácil Alvarado Martel, Daniel Hernández Obregón, Dulce N Hernández Correa, Elsa Espinosa Pozuelo, Elsa Florido Mayor, Engracia Pinilla Domínguez, Fátima Herrera García, Félix Bonilla Aguiar, Fernando Montón Álvarez, Francisco Cabrera López, Gloria Guerra de la Torre, Gregorio Muelas Martín, Guillermo Monzón, Héctor de la Rosa Merino, Ignacio García Puente, Ignacio Llorente Gómez de Segura, Isabel García Calcerrada, Iván Castilla Rodríguez, Jacqueline Álvarez Pérez, Jorge Federico Aldunate Page, Jose Antonio García Dopico, Juan Andrés Báez Hernández, Juan José Pérez Valencia, Julia Charlotte Wiebe, Lilisbeth Perestelo Pérez, Leopoldo Martín, Lluis Serra Majem, Luis Morcillo Herrera, Marcos Estupiñán Ramírez, Margarita Roldán Ruano, María Del Mar Romero Fernández, María Inmaculada González Pérez, María Isabel Visuerte Morales, María Pino Afonso Medina, Marta Riaño Ruiz, Marta Tejera Santana, Mauro Boronat Cortés, Mercedes Lorenzo Medina, Miguel JuanMora García, Nayra Pérez Delgado, Pablo Pedrianez Martín, Pedro de Pablos Velasco, Pilar Peláez Alba, Rafael Valcárcel, Remedios Castro Sánchez, Rodrigo Abreu González, Rosa Borges Trujillo, Salvador Acosta González, Sybille Kaiser Girardot, Víctor Lorenzo Sellarés

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.

Keywords: diabetes & endocrinology; health economics; health informatics; primary care; quality in health care.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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