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Table 2—

Cost-effectiveness of a policy of introducing specialist nurse–led clinics to improve the care of hospital-managed patients with diabetes

Blood pressure controlLipid control
Specialist clinic   
    Total cost* $306,400 $306,400 
    Caseload/year 506/year 345/year 
    Cost/patient $605/patient $888/patient 
    Change in surrogate outcome 1.2 mmHg 0.28 mmol/l 
Treatment   
    Cost/QALY gained −$1,400/QALY $8,230/QALY 
    QALYs gained 0.53/patient 0.46/patient 
    Change in surrogate outcome 5.7 mmHg 1.7 mmol/l 
    Life expectancy 16.1 years 16.1 years 
Policy analysis 
\[{\Delta}\mathrm{CE}_{\mathrm{p,BP}}{=}\frac{5.7\ {\times}\ 605}{0.53\ {\times}\ 1.2}\ {-}\ 1,400\ {=}\ 5,420\ {-}\ 1,400\ {=}\ {=}\ {\pounds}4,020/\mathrm{QALY}\]
 
\[{\Delta}\mathrm{CE}_{\mathrm{p,lipid}}{=}\frac{1.7\ {\times}\ 888}{0.46\ {\times}\ 0.28}\ {+}\ 8,230\ {=}\ 11,720\ {+}\ 8,230\ {=}\ {\pounds}19,950/\mathrm{QALY}\]
 
Blood pressure controlLipid control
Specialist clinic   
    Total cost* $306,400 $306,400 
    Caseload/year 506/year 345/year 
    Cost/patient $605/patient $888/patient 
    Change in surrogate outcome 1.2 mmHg 0.28 mmol/l 
Treatment   
    Cost/QALY gained −$1,400/QALY $8,230/QALY 
    QALYs gained 0.53/patient 0.46/patient 
    Change in surrogate outcome 5.7 mmHg 1.7 mmol/l 
    Life expectancy 16.1 years 16.1 years 
Policy analysis 
\[{\Delta}\mathrm{CE}_{\mathrm{p,BP}}{=}\frac{5.7\ {\times}\ 605}{0.53\ {\times}\ 1.2}\ {-}\ 1,400\ {=}\ 5,420\ {-}\ 1,400\ {=}\ {=}\ {\pounds}4,020/\mathrm{QALY}\]
 
\[{\Delta}\mathrm{CE}_{\mathrm{p,lipid}}{=}\frac{1.7\ {\times}\ 888}{0.46\ {\times}\ 0.28}\ {+}\ 8,230\ {=}\ 11,720\ {+}\ 8,230\ {=}\ {\pounds}19,950/\mathrm{QALY}\]
 
*

Clinics were run by a specialist nurse: salary, on-costs, clinic rental, and administration were costed and converted to U.S. prices: U.K. £0.65 = 1 US 1$ (see text). Clinic invitations are assumed to be repeated annually; future costs were discounted at 5% per annum.

Estimation using formula (Fig. 1), policy cost per life-year gained, and 95% CI shown in parentheses. Future costs and benefits were discounted at 5% per annum.

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