EFFECTIVENESS AND COST-EFFECTIVENESS OF A TWO-YEAR SHORT MESSAGING SERVICE (SMS) INTERVENTION FOR PROFESSIONAL DRIVERS WITH PRE-DIABETES
Author(s)
Wong CK1, Siu S2, Wong CK2, Yu EY1, Lam CL1
1The University of Hong Kong, Hong Kong, Hong Kong, 2Tung Wah Eastern Hospital, Hong Kong Island, Hong Kong
OBJECTIVES: An observational post-randomized controlled trial (RCT) design was adopted to evaluate the long-term sustainability and maintenance of improved glycemic control, lipid profile, and reduced progression to diabetes at 3-year following a 2-year intervention of short messaging service (SMS). METHODS: We performed a naturalistic follow-up to the 104 participants of SMS intervention, a 2-year RCT comparing SMS to non-SMS for professional drivers with pre-diabetes (ClinicalTrials.gov Identifier: NCT01556880). Primary outcome of this post-RCT study was cumulative incidence of diabetes whereas secondary outcomes were the change in biometric data over a 5-year period. Proportional Cox regression model was constructed to estimate hazard ratio (HR) of SMS for progression to diabetes. Incremental cost-effectiveness ratio for the SMS versus non-SMS was expressed in cost (2015 price in US dollar) per quality-adjusted life-year (QALY). Uncertainty about ICER was incorporated using bootstrapping. RESULTS: After a mean 57-month follow-up, 19 (18.3%) were lost to follow-up after the RCT period. No significantly greater benefit of SMS over 5-year period was observed in weight, body mass index, glycemic control, and lipid profile and diabetes risk scores. Thus no significant effect of SMS on reduction in diabetes was observed in overall (HR: 1.184; 95%CI: 0.612-2.288) and pre-defined subgroups. In term of cost-effectiveness, there were no significant differences in total costs (SMS: $880.21; non-SMS: $1327.51; difference: -447.30 95%CI: -447.30-488.38) and QALYs (SMS: 3.69; non-SMS: 3.68; difference: 0.01 95%CI: -0.01-0.04) between groups. Probabilities that SMS was cost-effective compared with non-SMS at a willingness-to-pay threshold of $10,000 and $50,000 per QALY gained were 87.3% and 87.5%, respectively. CONCLUSIONS: Based on post-RCT data, SMS intervention preserved the clinical benefits within the 3-year after intervention but it failed to translate from treatment efficacy to long-term effectiveness beyond 3 years. However, SMS was effective for delaying the diabetes progression, making it cost-effective over the 5-year period.
Conference/Value in Health Info
2017-05, ISPOR 2017, Boston, MA, USA
Value in Health, Vol. 20, No. 5 (May 2017)
Code
PDB44
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Diabetes/Endocrine/Metabolic Disorders