Table 1.
Costs of the DESMOND intervention
| Category and details of cost | Level cost incurred | Cost based on the trial of the DESMOND intervention6 | Cost in the “real world” | ||||
|---|---|---|---|---|---|---|---|
| Cost (£) | Basis | Cost (£) | Basis | ||||
| Delivery of the DESMOND intervention | |||||||
| Educators | DESMOND course | 531 | Two educators per course for two days per course, at £128 per day | 479 | One educator per course for one day per course, at top of band 6 (£39 701 per year including costs) | ||
| Refreshments | Patient | 4 | Average of £3 per patient for a one day course or £1.50 if course split over two days; scaled up to include cost of guests (assumed ratio of patients to guests=5:3) | 1 | Estimate (less than during trial as no lunch provided in “real world”) | ||
| Handbook | Patient | 12 | — | 5 | — | ||
| Disposable course materials (for example, flipcharts, worksheets) | DESMOND course | 6 | — | 8 | — | ||
| Course materials (for example, food, models) | Primary care trust* | 630 | — | 0 | Included in £675 starter pack from DESMOND central office | ||
| Non-perishable “food models” | Primary care trust | Covered within “sundries” cost below | — | 18 | — | ||
| Leaflets and postage (for example, letter confirming date, letter to practice) | Patient | 2 | — | 2 | — | ||
| Venue | DESMOND course | Not applicable | Included within £400 sundry payment to primary care trust | 25 | Estimate based on feedback from primary care trusts; can vary by a large amount depending on local circumstances | ||
| Sundries | Primary care trust | 400 | None assumed research cost | 0 | Itemised above | ||
| Training costs | |||||||
| Courses to train educators | Trial* | 30 224† | Training days | Included in fees (see “Programme fees from DESMOND central office” below) | — | ||
| Sundry course resources | Trial* | 9 | — | Included in fees (see “Programme fees from DESMOND central office” below) | — | ||
| Quality assurance of educators | |||||||
| Educator time and travel | Not applicable | 0 | Quality assurance done while courses running | Included in fees (see “Programme fees from DESMOND central office” below) | — | ||
| Quality assurers’ time and travel‡ | Educator* | 181 | Two educators were assessed at each visit; total 11 visits | Included in fees (see “Programme fees from DESMOND central office” below) | — | ||
| Programme fees from DESMOND central office | |||||||
| Training three educators (year one) | Primary care trust* | Not applicable | — | 2385 | £360 each for three educators per primary care trust per year | ||
| Quality assurers’ fees and travel (years two and three) | Primary care trust* | Not applicable | — | 1001 | — | ||
| Annual fee for accreditation (year two onwards) | Primary care trust* | Not applicable | — | 300 | £50 per educator per year | ||
| Starter pack | Primary care trust* | Not applicable | — | 675 | — | ||
| Programme fee§ | Primary care trust* | Not applicable | — | 4943 | 0.015p per patient in primary care trust per year | ||
| Coordination and indirect costs incurred by primary care trusts | |||||||
| Coordination time (for example, booking patients on course, sending letters, booking rooms) | DESMOND course | 127 | Expected to do five courses in trial | 59 | 3.5 hours per course at Band 4 (£20 821 per year including costs) | ||
| Within trial central office costs (delivery only) | |||||||
| Element to annuitise (for example, arranging training) | Trial* | 742 | 0.5 days per month for 15 months | Not applicable | — | ||
| Element relating to trial period | Trial | 742 | — | Not applicable | — | ||
DESMOND, diabetes education and self management for ongoing and newly diagnosed.
Educators’ travel costs were deemed to be negligible because these costs would not be claimed if the course was held locally or no further than the distance to workplace.
*The benefits of these resources accrue over several years. We conservatively spread out such costs over a period of three years.
†£30<thin>224 was the cost of training 26 educators on two courses. The courses took two days and were necessarily residential to allow participation of educators from all over the country. This outlay contributed £69 towards the cost per patient of delivering the DESMOND course during the trial (including overheads).
‡For the trial, this cost was averaged across 13 primary care trusts because not all trusts received a quality assurance visit.
§Dependent on size of primary care trust. Total calculated from average primary care trust size.