A model based on NHS England’s approach indicates that structured lifestyle interventions could improve health outcomes and save costs in Canada, though benefits vary with age and duration of effect.
A diabetes prevention programme modelled on the NHS England approach could offer good value for money in Canada, according to a study in the Canadian Medical Association Journal that looked at how a structured lifestyle intervention might perform in Quebec and Ontario. The analysis suggests that the programme would both improve health outcomes and reduce spending over time, although the size of the benefit was modest and depended heavily on how long the intervention effect lasts.
Using a cohort-based Markov model over 35 years, the researchers estimated that the programme would add 0.060 quality-adjusted life-years per participant while lowering average costs by about $244 in Quebec and $242 in Ontario. In most simulations, it remained both cheaper and more effective than usual care, with that outcome occurring in 74.8% of runs in Quebec and 74.7% in Ontario, indicating a strong likelihood of cost-effectiveness in those provinces.
The projected reduction in diabetes itself was smaller than the financial benefit. At 10 years, the model estimated 288.4 cases of type 2 diabetes per 1,000 participants under usual care compared with 273.1 with the programme, a difference of 15.3 per 1,000. By 35 years, the gap narrowed to 101.0 versus 99.1. The economic case also weakened with age: estimated savings fell from $565 per participant in people under 40 to $71 among those aged 70 to 79, and the intervention was no longer cost-saving in those aged 80 and older, although it still produced health gains at low extra cost.
The authors based the main effectiveness input on the NHS England programme’s adjusted hazard ratio of 0.80 over 36 months and applied that effect for the first three years before reverting to usual-care rates. They noted that the estimate already reflects the fact that about 47% of referred people never attended a session. The paper also found that if the benefit lasted longer, the economics improved further: extending the effect to 10 or 15 years increased gains to between 0.097 and 0.105 QALYs and generated savings of $402 to $438 per participant. Across sensitivity analyses, the likelihood of cost-effectiveness at a threshold of $50,000 per QALY ranged from 98.7% to 100%.
The authors said the model had important limits. It did not include screening and referral costs, did not separately model complications of diabetes, and left out wider social costs such as lost productivity. They also cautioned against assuming the NHS England programme would work in the same way for Indigenous communities, arguing that Indigenous-led approaches are needed. That warning matters because prevention strategies often perform differently outside the populations in which they were first tested.
The broader role of pharmacists in diabetes care is already supported by the Centres for Disease Control and Prevention, which says pharmacists can work with physicians to identify and resolve medication problems, help patients manage their conditions, support adherence, recommend vaccines and refer people to diabetes self-management education. The CDC also says pharmacists can play a part in prevention by identifying prediabetes, screening patients and referring them into the National Diabetes Prevention Programme. In a separate study published in the Journal of the American Pharmacists Association, a pharmacist-led diabetes management programme at a federally qualified health centre was linked with a fall in mean HbA1c from 10.1% to 8.5% among patients with follow-up data, though the authors noted that the absence of a control group made it hard to separate the effect of the pharmacists from other factors.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
