Estimating the long-term cost-effectiveness of a free online Diabetes Self-Management Education and Support service in England: Healthy living for people with type 2 diabetes, using a matched cohort study design

AIMS: The National Health Service (NHS) offers Healthy Living, an online Diabetes Self-Management Education and Support service, to help people Self Manage Type 2 Diabetes, with modest 1-year reductions in HbA1c levels, systolic blood pressure and body mass index. We aim to assess the cost-effectiveness of Healthy Living compared with usual care. METHODS: A patient-level economic simulation model (UKPDS-OM2.1) was used to conduct an economic analysis from the NHS perspective over a lifetime horizon, discounted at 3.5%. The model translated risk factor reductions to long-term cost and quality-adjusted life year (QALY) estimates. Additional analyses estimated intervention and medication cost consequences. RESULTS: The UKPDS-OM2.1 predicted a modest improvement in health (0.016 QALYs) and a small reduction in lifetime healthcare costs (-£4 per person). Offsetting with intervention costs (£7 per user) and increased medication costs (£212 per user) yielded a net cost of £216 per user. The cost-per-QALY of £13,192 was below the lower NICE threshold (£25,000/QALY), indicating that the programme is cost-effective. Sensitivity analyses largely demonstrated robustness, but the finding was sensitive to structural assumptions about disease progression post-intervention with the inclusion of medication costs. CONCLUSION: Healthy Living appears to be a low-cost, online intervention for self managing type 2 diabetes, generating modest health benefits that are likely to be considered cost-effective use of NHS resources. While there is some uncertainty in the cost-effectiveness and the modelling is based on effectiveness estimated from observational data, improvements in uptake and adherence has the potential to improve the value for money to the NHS.