OBJECTIVES: Kids in Control OF Food (KICk-OFF) is a 5-day structured education programme for 11-16 year olds who use multiple daily insulin injections. This study evaluates whether KICk-OFF would be considered a cost-effective use of NHS resources by decision makers in the UK.
METHODS: A cost-effectiveness analysis comparing KICk-OFF to usual care was conducted. Data from the KICk-OFF trial were extrapolated to simulate lifetime outcomes using the Sheffield Type 1 Diabetes Policy Model. Baseline patient characteristics and effectiveness on HbA1c, severe hypoglycaemia and diabetic ketoacidosis came from trial data. In the model HbA1c is the key predictor of future events (retinopathy, neuropathy, nephropathy, myocardial infarction, stroke, revascularization and angina). KICk-OFF implementation costs were calculated using data from participating trial centres. Analyses was conducted in the full cohort and a high baseline HbA1c (>9.5%) subgroup. Treatment effect durations of 2 years, 4 years and lifetime were tested. Uncertainty was examined using probabilistic sensitivity analysis.
RESULTS: Using the full cohort and a 4 year treatment effect duration, KICk-OFF provided more quality adjusted life years (+0.0394 QALYs) at a higher cost (£1,135) per person than usual care. The incremental cost per QALY gained was £28,813 per QALY gained, just within the range of £20,000 to £30,000 which NICE would consider cost-effective (42.6% chance of being below £20,000). This value changed considerably with the treatment effect duration. For the high HbA1c sub-group, KICk-OFF was dominant i.e. provided more QALYs (+0.2012) at a lower cost (-£4,423) per person (96.4% chance of being below £20,000). This result was robust to different treatment effect durations.
CONCLUSIONS: For the whole study population, whether KICk-OFF is cost-effective depends on the long-term treatment effect duration. For the high baseline HbA1c sub-group, KICk-OFF was found to be cost-effective.
