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The aims of the study were to estimate the within-trial and lifetime cost-effectiveness of the weight management programme, which achieved 46% remissions of type 2 diabetes at year 1 and 36% at year 2 in the Diabetes Remission Clinical Trial (DiRECT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Within-trial analysis assessed costs of the Counterweight-Plus intervention in DiRECT (including training, programme materials, practitioner appointments and low-energy diet), along with glucose-lowering and antihypertensive medications, and all routine healthcare contacts. Lifetime cost per quality-adjusted life-year (QALY) was estimated according to projected durations of remissions, assuming continued relapse rates as seen in year 2 of DiRECT and consequent life expectancy, quality of life and healthcare costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean total 2\u00a0year healthcare costs for the intervention and control groups were \u00a33036 and \u00a32420, respectively: an incremental cost of \u00a3616 (95% CI \u2013\u00a345, \u00a31269). Intervention costs (\u00a31411; 95% CI \u00a31308, \u00a31511) were partially offset by lower other healthcare costs (\u00a3796; 95% CI \u00a3150, \u00a31465), including reduced oral glucose-lowering medications by \u00a3231 (95% CI \u00a3148, \u00a3314). Net remission at 2\u00a0years was 32.3% (95% CI 23.5%, 40.3%), and cost per remission achieved was \u00a31907 (lower 95% CI: intervention dominates; upper 95% CI: \u00a34212). Over a lifetime horizon, the intervention was modelled to achieve a mean 0.06 (95% CI 0.04, 0.09) QALY gain for the DiRECT population and mean total lifetime cost savings per participant of \u00a31337 (95% CI \u00a3674, \u00a32081), with the intervention becoming cost-saving within 6\u00a0years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>Incorporating the lifetime healthcare cost savings due to periods of remission from diabetes and its complications, the DiRECT intervention is predicted to be both more effective (QALY gain) and cost-saving in adults with type 2 diabetes compared with standard care. This conclusion appears robust to various less favourable model scenarios, providing strong evidence that resources could be shifted cost-effectively to support achieving remissions with the DiRECT intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ISRCTN03267836<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-020-05224-2","type":"journal-article","created":{"date-parts":[[2020,8,10]],"date-time":"2020-08-10T11:03:44Z","timestamp":1597057424000},"page":"2112-2122","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Type 2 diabetes remission: 2\u00a0year within-trial and lifetime-horizon cost-effectiveness of the Diabetes Remission Clinical Trial (DiRECT)\/Counterweight-Plus weight management programme"],"prefix":"10.1007","volume":"63","author":[{"given":"Yiqiao","family":"Xin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Davies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Briggs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"McCombie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. 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