Cost-effectiveness of home versus hospital management of children at onset of type 1 diabetes: the DECIDE randomised controlled trial Article Swipe
Zoe McCarroll
,
Julia Townson
,
Timothy Pickles
,
John W Gregory
,
Rebecca Playle
,
Michael Robling
,
Dyfrig Hughes
·
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1136/bmjopen-2020-043523
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1136/bmjopen-2020-043523
Objective The aim of this economic evaluation was to assess whether home management could represent a cost-effective strategy in the patient pathway of type 1 diabetes (T1D). This is based on the Delivering Early Care In Diabetes Evaluation trial ( ISRCTN78114042 ), which compared home versus hospital management from diagnosis in childhood diabetes and found no statistically significant difference in glycaemic control at 24 months. Design Cost-effectiveness analysis alongside a randomised controlled trial. Setting Eight paediatric diabetes centres in England, Wales and Northern Ireland. Participants 203 clinically well children aged under 17 years, with newly diagnosed T1D and their carers. Outcome measures The base-case analysis adopted n National Health Service (NHS) perspective. A scenario analysis assessed costs from a broader societal perspective. The incremental cost-effectiveness ratio (ICER), expressed as cost per mmol/mol reduction in glycated haemoglobin (HbA1c), was based on the mean difference in costs between the home and hospital groups, divided by mean differences in effectiveness (HbA1c). Uncertainty was considered in terms of the probability of cost-effectiveness. Results At 24 months postintervention, the base-case analysis showed a difference in costs between home and hospital, in favour of home management (mean difference −£2,217; 95% CI −£2825 to −£1,609; p<0.001). Home care dominated, with an ICER of £7434 (saved) per mmol/mol reduction of HbA1c. The results of the scenario analysis also favoured home management. The greatest driver of cost differences was hospitalisation during the initiation period. Conclusions Home management from diagnosis of children with T1D who are medically stable represents a less costly approach for the NHS in the UK, without impacting clinical effectiveness. Trial registration number ISRCTN78114042 .
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1136/bmjopen-2020-043523
- https://bmjopen.bmj.com/content/bmjopen/11/5/e043523.full.pdf
- OA Status
- gold
- Cited By
- 5
- References
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- Related Works
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- OpenAlex ID
- https://openalex.org/W3163112646
All OpenAlex metadata
Raw OpenAlex JSON
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https://openalex.org/W3163112646Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1136/bmjopen-2020-043523Digital Object Identifier
- Title
-
Cost-effectiveness of home versus hospital management of children at onset of type 1 diabetes: the DECIDE randomised controlled trialWork title
- Type
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articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2021Year of publication
- Publication date
-
2021-05-01Full publication date if available
- Authors
-
Zoe McCarroll, Julia Townson, Timothy Pickles, John W Gregory, Rebecca Playle, Michael Robling, Dyfrig HughesList of authors in order
- Landing page
-
https://doi.org/10.1136/bmjopen-2020-043523Publisher landing page
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https://bmjopen.bmj.com/content/bmjopen/11/5/e043523.full.pdfDirect link to full text PDF
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YesWhether a free full text is available
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-
goldOpen access status per OpenAlex
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https://bmjopen.bmj.com/content/bmjopen/11/5/e043523.full.pdfDirect OA link when available
- Concepts
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Medicine, Glycated haemoglobin, Pediatrics, Randomized controlled trial, Diabetes mellitus, Cost-effectiveness analysis, Type 1 diabetes, Diabetes management, Cost effectiveness, Emergency medicine, Cost–benefit analysis, Type 2 diabetes, Surgery, Biology, Ecology, Risk analysis (engineering), EndocrinologyTop concepts (fields/topics) attached by OpenAlex
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5Total citation count in OpenAlex
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2025: 1, 2024: 2, 2023: 1, 2021: 1Per-year citation counts (last 5 years)
- References (count)
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31Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.difference | 58, 142, 178, 191 |
| abstract_inverted_index.dominated, | 201 |
| abstract_inverted_index.evaluation | 6 |
| abstract_inverted_index.initiation | 233 |
| abstract_inverted_index.management | 12, 47, 189, 237 |
| abstract_inverted_index.paediatric | 75 |
| abstract_inverted_index.randomised | 70 |
| abstract_inverted_index.represents | 248 |
| abstract_inverted_index.Conclusions | 235 |
| abstract_inverted_index.Uncertainty | 158 |
| abstract_inverted_index.differences | 154, 228 |
| abstract_inverted_index.haemoglobin | 135 |
| abstract_inverted_index.incremental | 123 |
| abstract_inverted_index.management. | 222 |
| abstract_inverted_index.probability | 165 |
| abstract_inverted_index.significant | 57 |
| abstract_inverted_index.−£1,609; | 197 |
| abstract_inverted_index.−£2,217; | 192 |
| abstract_inverted_index.Participants | 84 |
| abstract_inverted_index.p<0.001). | 198 |
| abstract_inverted_index.perspective. | 111, 121 |
| abstract_inverted_index.registration | 264 |
| abstract_inverted_index.effectiveness | 156 |
| abstract_inverted_index.statistically | 56 |
| abstract_inverted_index.ISRCTN78114042 | 40, 266 |
| abstract_inverted_index.cost-effective | 16 |
| abstract_inverted_index.effectiveness. | 262 |
| abstract_inverted_index.hospitalisation | 230 |
| abstract_inverted_index.postintervention, | 172 |
| abstract_inverted_index.Cost-effectiveness | 66 |
| abstract_inverted_index.cost-effectiveness | 124 |
| abstract_inverted_index.cost-effectiveness. | 167 |
| cited_by_percentile_year.max | 96 |
| cited_by_percentile_year.min | 89 |
| corresponding_author_ids | https://openalex.org/A5037154902 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 7 |
| corresponding_institution_ids | https://openalex.org/I79510175 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.46000000834465027 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.68524723 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |