Background Type 2 Diabetes Mellitus (T2DM) and obesity are highlighted as the main reasons for the increase in Non-communicable Disease (NCD) incidence in the last decades. The NHS Diabetes Prevention Programme (NHS-DPP) was rolled-out in 2016, intending to reduce or delay T2DM in the population, offering lifestyle advice to reduce weight and HbA1c levels in the at-risk population. In this study, we model long-term health, equity and cost-effectiveness outcomes of a weight-reduction lifestyle intervention when added as part of the NHS Health Checks (NHSHCs) programme.
Methods We used the WorkHORSE tool to model NHSHCs scenarios, powered by the IMPACTNCD stochastic dynamic microsimulation. We used R v4.04. We defined the baseline as the current implementation of the NHSHCs programme. Invite and uptake percentages are based on NHS Digital reports; prescription (pharmacological and smoking cessation) and cost data are based on our work evaluating NHSHCs. We defined three policy scenarios for the weight-reduction lifestyle intervention, modelled using empirical data from the NHS-DPP first two years:1) reported annual capacity, 2.5% mean weight loss as percentage weight in intention-to-treat population, cost per completer £435;2) as Scenario 1) but annual capacity is doubled;3) as Scenario 1) but mean weight loss is 4.0% (observed in completers population). The simulation period was 2020–2039, attrition rate 20% and standard UK Treasury discount rates were applied.
Results Preliminary results suggest that in Scenario 1) approximately 2,000 (95% Uncertainty Interval (UI): -370 to 4300) T2DM cases could be prevented or postponed. However, when assumed capacity doubled or a higher weight effect was used although in a smaller group, Scenarios 2) and 3) prevented or postponed 3,500 (95% UI: 1,300 to 6,200) and 2,000 (95% UI: -650, 4000) T2DM cases respectively. Case years prevented or postponed in each scenario are 16,000 (95% UI:-5000 to 39,000), 32,000 (95% UI: 9,500 to 56,000) and 17,000 (95% UI: -7200 to 37,000) respectively. Compared to the baseline, no scenario was more cost-effective nor reduced health inequalities; in all cases the probability of becoming cost-effective or equitable did not reach 80%.
Conclusion Results suggest the intervention has the potential to reduce T2DM incidence but requires substantial participation and increased long-term effectiveness. The effects in other NCDs, cost-effectiveness and health inequalities were uncertain.Whilst reduction in T2DM is encouraging, a combination of high-risk and structural policies is needed to reduce the health inequalities gap and address the NCDs crisis, which is urgently overdue.
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