{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T15:35:02Z","timestamp":1783524902765,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T00:00:00Z","timestamp":1774742400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T00:00:00Z","timestamp":1774742400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000361","name":"Diabetes UK","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000361","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Follow\u2010up of the Counterweight\u2010Plus intervention in DiRECT has demonstrated 6.1\u2009kg weight loss and 10 % remissions from type 2 diabetes at 5\u2009years. We previously reported cost\u2010effectiveness based on 2\u2010year results. We now present an updated cost\u2010effectiveness analysis, based on available 5\u2010year data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A lifetime cost\u2010effectiveness analysis was conducted using the 5\u2010year data from DiRECT, including time to relapse from remission from type 2 diabetes, intervention costs (practitioner appointment visits, low\u2010energy formula diet sachets), routine healthcare resource use (primary, secondary, and tertiary care contacts), medications (anti\u2010hypertensive and anti\u2010diabetic medicines), and quality of life (EuroQol EQ\u20105D\u20103L). Modelling assumed that all those in remission at 5\u2009years would relapse after a maximum of 10\u2009years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Total (discounted) healthcare cost\u2010savings (excluding intervention costs) per participant over 5\u2009years amounted to \u00a32091. On average, healthcare costs per annum were ~\u00a3480 per participant lower in the intervention arm (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Intervention resource use beyond 2\u2009years added relatively little to the total intervention cost (set\u2010up, formula diet and practice visits), which amounted to \u00a31691 (95% CI: \u00a31566, 1822) per participant over 5\u2009years. Reduced hospital admissions accounted for the major part of this saving, with the remainder being across primary and secondary care, and anti\u2010diabetic and anti\u2010hypertensive medications. Remission in DiRECT was associated with a significant improvement in quality of life, and the intervention arm was modelled to achieve both cost\u2010savings of ~\u00a3400 and quality adjusted life year gains of 0.043 over 5\u2009years, with further benefits due to reduced mortality in remission. Over the full lifetime horizon of the analysis the intervention was modelled to produce 0.08 incremental QALYs, saving \u00a3496 per participant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The costs involved in achieving remissions from type 2 diabetes with the Counterweight\u2010Plus diet programme were offset within 5\u2009years through reduced healthcare resource use. Though remission may ultimately relapse, sustained weight loss brings other longer term health gains. The intervention, even using one\u2010to\u2010one face\u2010to\u2010face contacts rather than remote delivery, which is increasingly adopted, generated both health gains and cost\u2010savings compared with current best practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dme.70306","type":"journal-article","created":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T09:13:58Z","timestamp":1774775638000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost\u2010effectiveness of the diabetes remission clinical trial (\n                    <scp>DiRECT<\/scp>\n                    )\/Counterweight\u2010Plus weight management programme, based on 5\u2010year follow\u2010up"],"prefix":"10.1111","volume":"43","author":[{"given":"A.","family":"Davies","sequence":"first","affiliation":[{"name":"Health Economics and Health Technology Assessment, School of Health and Wellbeing, College of Medical, Veterinary &amp; Life Sciences University of Glasgow  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4115-2882","authenticated-orcid":false,"given":"E.","family":"Grieve","sequence":"additional","affiliation":[{"name":"Health Economics and Health Technology Assessment, School of Health and Wellbeing, College of Medical, Veterinary &amp; Life Sciences University of Glasgow  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"McCombie","sequence":"additional","affiliation":[{"name":"Human Nutrition, School of Medicine, Dentistry &amp; Nursing, College of Medical, Veterinary &amp; Life Sciences University of Glasgow  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"McIntosh","sequence":"additional","affiliation":[{"name":"Robertson Centre for Biostatistics, School of Health and Wellbeing, College of Medical, Veterinary &amp; Life Sciences University of Glasgow  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"McConnachie","sequence":"additional","affiliation":[{"name":"Robertson Centre for Biostatistics, School of Health and Wellbeing, College of Medical, Veterinary &amp; Life Sciences University of Glasgow  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. S.","family":"Leslie","sequence":"additional","affiliation":[{"name":"Human Nutrition, School of Medicine, Dentistry &amp; Nursing, College of Medical, Veterinary &amp; Life Sciences University of Glasgow  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1604-2593","authenticated-orcid":false,"given":"N.","family":"Sattar","sequence":"additional","affiliation":[{"name":"School of Cardiovascular and Metabolic Health, College of Medical, Veterinary &amp; Life Sciences University of Glasgow  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine Newcastle University  Newcastle upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2216-0083","authenticated-orcid":false,"given":"M. E. 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