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.