Model Finds NHS England–Style Diabetes Prevention Program Cost-Effective

Implementing a diabetes prevention program (DPP) modeled on the one run by the National Health Service (NHS) England would be cost-effective in Ontario and Quebec and likely cost saving over 35 years for adults with prediabetes, according to a modeling study published in CMAJ. The authors estimated that the program would add 0.060 quality-adjusted life-years (QALYs) per participant while lowering mean costs by $244 per participant in Quebec and $242 in Ontario. All dollar figures are Canadian.¹

No Canadian province has implemented a publicly funded DPP, the authors wrote, despite estimates that as many as a quarter of adults in the country live with prediabetes. England launched the world's first nationwide, publicly funded DPP in 2016. It delivers structured behavior-change sessions over 9 to 12 months, focused on diet, physical activity, and weight management, and the authors cited a drop in diabetes incidence among people with prediabetes from 64.3 to 53.4 per 1000 person-years.¹

What the Model Showed

The team built a cohort-state transition Markov model with four health states: normal glucose tolerance, prediabetes, type 2 diabetes, and death. It compared usual care with usual care plus referral to an NHS England–style DPP, run separately for Quebec and Ontario from a health care system perspective. Costs are in 2025 Canadian dollars.¹

Mean total costs were $101,833 per participant in Quebec and $101,835 in Ontario with the DPP, compared with $102,077 for usual care. The gain of 0.060 QALYs per participant had a 95% uncertainty range of 0.024 to 0.094. Program costs per participant were $762.70 in Quebec and $918.71 in Ontario, a difference the authors attributed to province-specific wage assumptions.¹

Across 10,000 simulations, the DPP was both less costly and more effective than usual care in 74.8% of runs in Quebec and 74.7% in Ontario. In the rest, it produced more QALYs at higher cost, but every one of those simulations stayed cost-effective at a threshold of $50,000 per QALY gained.¹

The modeled effect on diabetes burden was smaller. At 10 years, the DPP reduced the number of people with type 2 diabetes from 288.4 to 273.1 per 1000 participants, or 15.3 fewer per 1000. At 35 years, the figures were 101.0 and 99.1.¹

Age mattered. Cost savings generally shrank as the starting age rose, from $565 per participant among people younger than 40 years to $71 among those aged 70 to 79 years. Among those 80 years or older, the DPP was no longer cost saving but still produced QALY gains at minimal incremental cost.¹

Assumptions Behind the Estimates

The effectiveness input came from the NHS England DPP's adjusted hazard ratio of 0.80 (95% CI, 0.73-0.87) over 36 months. The model applied it for the first 3 years and then reverted to usual-care transition probabilities.¹

That estimate includes the 47% of referred people who never attended a session. The authors said landmark trials reported 30% to 70% reductions in type 2 diabetes incidence, and referral to the NHS England DPP was associated with a 20% relative reduction.¹

If the effect lasts longer, the numbers improve. Extending it to 10 or 15 years produced 0.097 to 0.105 additional QALYs and savings of $402 to $438 per participant. Across all sensitivity analyses, the probability of cost-effectiveness at $50,000 per QALY ranged from 98.7% to 100%.¹

The authors also listed limitations. The model excluded screening and referral costs, did not include an explicit state for diabetes complications, and left out societal costs such as productivity losses. They wrote that the NHS England DPP and its effectiveness cannot be assumed to apply to Indigenous communities, which require Indigenous-led approaches.¹

Where Pharmacists Fit in Diabetes Care

The CMAJ analysis models a lifestyle program for people with prediabetes. Pharmacist involvement in diabetes care is documented elsewhere. The CDC says pharmacists work directly with physicians to identify, prevent, and resolve medication-related problems, a partnership it calls collaborative drug therapy management. CDC's guidance states that this approach is associated with improved blood sugar control in people with diabetes. It adds that pharmacists can advise patients on self-management, help them take medicines as prescribed, provide recommended vaccines, and refer them to diabetes self-management education and support services.²

A retrospective study in the Journal of the American Pharmacists Association looked at a pharmacist-led Comprehensive Diabetes Management Program at a federally qualified health center. Clinical pharmacists and a licensed dietitian served patients whose most recent hemoglobin A1c exceeded 7%, so the program addressed existing diabetes rather than prevention. Among 477 patients with follow-up values, mean A1c fell from 10.1% (SD, 2.1) to 8.5% (SD, 2.1) (P < .0001).³

The same study reported that hospital and emergency department charges in the 12 months before enrollment totaled $957,421 across 103 patients, compared with $657,056 across 82 patients in the 12 months after. The authors noted that the lack of a comparison group made it difficult to attribute improvements to the pharmacist-led intervention and that the dietitian's contribution needed to be considered alongside the pharmacists' work.³

REFERENCES

1. Gupta N, Valabhji J, McManus E, Rahme E, Campbell JR, Dasgupta K. Cost-effectiveness of implementing the National Health Service England Diabetes Prevention Programme in Canada: a modelling study. CMAJ. 2026;198(33):E1282-E1294. Published 2026 Sep 27. doi:10.1503/cmaj.260187

2. Promoting medication management. Diabetes. Centers for Disease Control and Prevention. Published May 15, 2024. Accessed September 29, 2026. https://www.cdc.gov/diabetes/hcp/clinical-guidance/promote-medication-management.html

3. Rochester-Eyeguokan CD, Pincus KJ, Sokan OM, Seung H. The impact of a pharmacist-led Comprehensive Diabetes Management Program in a Federally Qualified Health Center. J Am Pharm Assoc (2003). 2025;65(4):102399. doi:10.1016/j.japh.2025.102399