Cost-effectiveness of a Novel Hypoglycaemia Programme: The ‘HARPdoc vs BGAT’ RCT

AimsTo assess the cost‐effectiveness of HARPdoc (Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes and problematic hypoglycaemia despite optimised care), focussed upon cognitions and motivation, versus BGAT (Blood Glucose Awareness Training), focussed on behaviours and education, as adjunctive treatments for treatment‐resistant problematic hypoglycaemia in type 1 diabetes, in a randomised controlled trial.MethodsEligible adults were randomised to either intervention. Quality of life (QoL, measured using EQ‐5D‐5L); cost of utilisation of health services (using the adult services utilization schedule, AD‐SUS) and of programme implementation and curriculum delivery were measured. A cost‐utility analysis was undertaken using quality‐adjusted life years (QALYs) as a measure of trial participant outcome and cost‐effectiveness was evaluated with reference to the incremental net benefit (INB) of HARPdoc compared to BGAT.ResultsOver 24 months mean total cost per participant was £194 lower for HARPdoc compared to BGAT (95% CI: −£2498 to £1942). HARPdoc was associated with a mean incremental gain of 0.067 QALYs/participant over 24 months post‐randomisation: an equivalent gain of 24 days in full health. The mean INB of HARPdoc compared to BGAT over 24 months was positive: £1521/participant, indicating comparative cost‐effectiveness, with an 85% probability of correctly inferring an INB > 0.ConclusionsAddressing health cognitions in people with treatment‐resistant hypoglycaemia achieved cost‐effectiveness compared to an alternative approach through improved QoL and reduced need for medical services, including hospital admissions. Compared to BGAT, HARPdoc offers a cost‐effective adjunct to educational and technological solutions for problematic hypoglycaemia.