Evidence mapPaperPMID 39933817Full record

Trial reportBMJ open2025

A model based cost-utility analysis of Embedding referral to structured self-management education into standard practice (Embedding) compared to usual care for people with type 2 diabetes diagnosis in the last 12 months in England.

Daniel John Pollard, Anju Keetharuth, Alan Brennan, Danielle H Bodicoat, Agnieszka Glab, Michelle Hadjiconstantinou, Joesph P Mensa, Alison Northern, Melanie J Davies

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Daniel John PollardSheffield Centre for Health And Related Research (SCHARR), School of Medicine and Population Health, The University of Sheffield, Sheffield, UK d.j.pollard@sheffield.ac.uk.ORCID http://orcid.org/0000-0001-5630-0115
Anju KeetharuthSheffield Centre for Health And Related Research (SCHARR), School of Medicine and Population Health, The University of Sheffield, Sheffield, UK.ORCID http://orcid.org/0000-0001-8889-6806
Alan BrennanSheffield Centre for Health And Related Research (SCHARR), School of Medicine and Population Health, The University of Sheffield, Sheffield, UK.
Danielle H BodicoatIndependent Researcher, Leicester, UK.
Agnieszka GlabLeicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK.
Michelle HadjiconstantinouLeicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK.
Joesph P MensaSheffield Centre for Health And Related Research (SCHARR), School of Medicine and Population Health, The University of Sheffield, Sheffield, UK.
Alison NorthernLeicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK.
Melanie J DaviesLeicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK.ORCID http://orcid.org/0000-0002-9987-9371

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo conduct a cost-utility analysis of an implementation package that has been developed aiming to embed the referral of people with type 2 diabetes mellitus (T2DM) to structured self-management education (SSME) from primary care into routine practice compared with usual care.

designModel-based cost-effectiveness analysis using the School for Public Health Research type 2 diabetes treatment model. With costs and effectiveness parameters coming from analyses of data from a cluster randomised control trial.

settingEnglish National Health Service.

participantsPeople with T2DM from 64 GP practices in England.

interventionsEmbedding SSME implementation package Usual care. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was the incremental cost-effectiveness ratio. Secondary outcome measures included the probability of Embedding implementation package being cost-effective and value of information.

resultsThe estimated cost of the intervention was £40 316 across the study sites, which equates to £0.521 per patient across all practices. For the base case, the estimated mean discounted incremental lifetime cost of the intervention per patient is £48.19. This is associated with a mean per patient incremental quality-adjusted life-year (QALY) estimate of 0.006, producing an incremental cost-effectiveness ratio of £8311 per QALY gained. This has a 73.1% probability of the intervention being cost-effective at a funding threshold of £20 000 per QALY gained. Scenario analyses indicate that alternative parameterisations can lead to this finding being overturned.

conclusionsThe effectiveness of the Embedding packages was hampered by the COVID-19 pandemic. However, our base case analysis shows that Embedding could be cost-effective for this patient population, but this was subject to significant structural uncertainty. This suggests that while implementation initiatives can be highly cost-effective in this population, more robust evidence or further incentivisation will be required before widespread adoption can be recommended. TRIAL REGISTRATION NUMBER: ISRCTN23474120, registered 05/04/2018.

Indexed as

Diabetes Mellitus, Type 2Patient Education as TopicReferral and ConsultationSelf-ManagementCost-Benefit AnalysisCOVID-19EnglandFemaleHumansMaleMiddle AgedPrimary Health CareQuality-Adjusted Life YearsDiabetes Mellitus, Type 2HEALTH ECONOMICSHealth EducationPrimary Care

Identifiers

PMID39933817
PMCPMC11815453

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.