scholarly journals Estimating the Impact of Novel Digital Therapeutics in Type 2 Diabetes and Hypertension: Health Economic Analysis

10.2196/15814 ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. e15814 ◽  
Author(s):  
Robert J Nordyke ◽  
Kevin Appelbaum ◽  
Mark A Berman
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Cohort Studies ◽  
Cost Savings ◽  
Economic Benefits ◽  
Sensitivity Analyses ◽  
Clinical Inertia ◽  
Health Resource ◽  
The Impact

Background Behavioral interventions can meaningfully improve cardiometabolic conditions. Digital therapeutics (DTxs) delivering these interventions may provide benefits comparable to pharmacologic therapies, displacing medications for some patients. Objective Our objective was to estimate the economic impact of a digital behavioral intervention in type 2 diabetes mellitus (T2DM) and hypertension (HTN) and estimate the impact of clinical inertia on deprescribing medications. Methods Decision analytic models estimated health resource savings and cost effectiveness from a US commercial payer perspective. A 3-year time horizon was most relevant to the intervention and payer. Effectiveness of the DTx in improving clinical outcomes was based on cohort studies and published literature. Health resource utilization (HRU), health state utilities, and costs were drawn from the literature with costs adjusted to 2018 dollars. Future costs and quality-adjusted life years (QALYs) were discounted at 3%. Sensitivity analyses assessed uncertainty. Results Average HRU savings ranged from $97 to $145 per patient per month, with higher potential benefits in T2DM. Cost-effectiveness acceptability analyses using a willingness-to-pay of $50,000/QALY indicated that the intervention would be cost effective at total 3-year program costs of $6468 and $6620 for T2DM and HTN, respectively. Sensitivity analyses showed that reduced medication costs are a primary driver of potential HRU savings, and the results were robust within values tested. A resistance to deprescribe medications when a patient’s clinical outcomes improve can substantially reduce the estimated economic benefits. Our models rely on estimates of clinical effectiveness drawn from limited cohort studies with DTxs and cannot account for other disease management programs that may be implemented. Performance of DTxs in real-world settings is required to further validate their economic benefits. Conclusions The DTxs studied may provide substantial cost savings, in part by reducing the use of conventional medications. Clinical inertia may limit the full cost savings of DTxs.

scholarly journals Estimating the Impact of Novel Digital Therapeutics in Type 2 Diabetes and Hypertension: Health Economic Analysis (Preprint)

2019 ◽  
Author(s):  
Robert J Nordyke ◽  
Kevin Appelbaum ◽  
Mark A Berman
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Cohort Studies ◽  
Cost Savings ◽  
Economic Benefits ◽  
Sensitivity Analyses ◽  
Clinical Inertia ◽  
Health Resource ◽  
The Impact

BACKGROUND Behavioral interventions can meaningfully improve cardiometabolic conditions. Digital therapeutics (DTxs) delivering these interventions may provide benefits comparable to pharmacologic therapies, displacing medications for some patients. OBJECTIVE Our objective was to estimate the economic impact of a digital behavioral intervention in type 2 diabetes mellitus (T2DM) and hypertension (HTN) and estimate the impact of clinical inertia on deprescribing medications. METHODS Decision analytic models estimated health resource savings and cost effectiveness from a US commercial payer perspective. A 3-year time horizon was most relevant to the intervention and payer. Effectiveness of the DTx in improving clinical outcomes was based on cohort studies and published literature. Health resource utilization (HRU), health state utilities, and costs were drawn from the literature with costs adjusted to 2018 dollars. Future costs and quality-adjusted life years (QALYs) were discounted at 3%. Sensitivity analyses assessed uncertainty. RESULTS Average HRU savings ranged from $97 to $145 per patient per month, with higher potential benefits in T2DM. Cost-effectiveness acceptability analyses using a willingness-to-pay of $50,000/QALY indicated that the intervention would be cost effective at total 3-year program costs of $6468 and $6620 for T2DM and HTN, respectively. Sensitivity analyses showed that reduced medication costs are a primary driver of potential HRU savings, and the results were robust within values tested. A resistance to deprescribe medications when a patient’s clinical outcomes improve can substantially reduce the estimated economic benefits. Our models rely on estimates of clinical effectiveness drawn from limited cohort studies with DTxs and cannot account for other disease management programs that may be implemented. Performance of DTxs in real-world settings is required to further validate their economic benefits. CONCLUSIONS The DTxs studied may provide substantial cost savings, in part by reducing the use of conventional medications. Clinical inertia may limit the full cost savings of DTxs.

Model estimates of the results of diabetes patients using modern glucometers with tri-color technology for displaying test results

2019 ◽  
pp. 81-89
Author(s):  
Larisa Dmitrievna Popovich ◽  
Svetlana Valentinovna Svetlichnaya ◽  
Aleksandr Alekseevich Moiseev
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Economic Benefits ◽  
Test Results ◽  
Self Monitoring ◽  
Patients With Diabetes ◽  
The Impact

Diabetes – a disease in which the effect of the treatment substantially depends on the patient. Known a study showed that the use of glucometers with the technology of three-color display of test results facilitates self-monitoring of blood sugar and leads to a decrease in glycated hemoglobin (HbAlc). Purpose of the study: to modeling the impact of using of a glucometer with a color-coded display on the clinical outcomes of diabetes mellitus and calculating, the potential economic benefits of reducing the hospitalization rate of patients with diabetes. Material and methods. Based on data from two studies (O. Schnell et al. and M. Baxter et al.) simulation of the reduction in the number of complications with the use of a glucometer with a color indication. In a study by O. Schnell et al. a decrease of HbA1c by 0.69 percent is shown when using the considered type of glucometers, which was the basis of the model. Results. In the model, the use of a glucometer with a color-coded display for type 1 diabetes led to a decrease in the total number of complications by 9.2 thousand over 5 years per a cohort of 40 thousand patients with different initial levels of HbA1c. In a cohort of 40 thousand patients with type 2 diabetes, the simulated number of prevented complications was 1.7 thousand over 5 years. When extrapolating these data to all patients with diabetes included in the federal register of diabetes mellitus (FRD), the number of prevented complications was 55.4 thousand cases for type 1 diabetes and 67.1 thousand cases for type 2 diabetes. The possible economic effect from the use of the device by all patients with a diagnosis of diabetes, which are included in the FRD, estimated at 1.5 billion rubles for a cohort of patients with type 1 diabetes and 5.3 billion rubles for patients with type 2 diabetes. Conclusion. Improving the effectiveness of self-monitoring, which is the result of the use of glucometers with color indicators, can potentially significantly reduce the incidence of complications in diabetes and thereby provide significant economic benefits to society.

scholarly journals The Impact of Suboptimal Diet on Type 2 Diabetes at Global, Regional, National, and Sub-National Levels: A Comparative Risk Assessment Analysis

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 877-877
Author(s):  
Meghan O'Hearn ◽  
Gitanjali Singh ◽  
Frederick Cudhea ◽  
Victoria Miller ◽  
Jianyi Zhang ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Risk Assessment ◽  
Whole Grains ◽  
Dietary Factors ◽  
Sub Saharan Africa ◽  
Sensitivity Analyses ◽  
Comparative Risk Assessment ◽  
Comparative Risk ◽  
The Impact

Abstract Objectives To prioritize dietary factors for reducing the growing burden of type 2 diabetes (T2D) worldwide, we estimated the impact of suboptimal diet on T2D incidence at global, regional, national, and subnational levels between 1990 and 2015. Methods A comparative risk assessment framework estimated T2D incidence attributable to suboptimal diet in strata jointly stratified by year, nation, age, and sex, across 185 countries. We estimated direct (dietary composition) etiologic effects of 8 factors including nuts/seeds, whole grains, yogurt, processed meats, unprocessed red meats, glycemic load (estimated from refined grains), sugar-sweetened beverages (SSBs) and potatoes. Population demographics were from the United Nations; stratum-specific mean dietary intakes and distributions from Global Dietary Database (GDD), diet-T2D etiologic effects from meta-analyses of prospective cohort studies; and T2D incidence from the Global Burden of Disease study. These inputs and their uncertainties were used to calculate the stratum-specific population attributable fraction (PAF) and then absolute attributable cases, with joint effects estimated using multiplicative PAFs. Results In 2015, suboptimal intakes of these 8 factors were jointly estimated to cause 10.9 million T2D cases (95% UI 7.2–15.3), representing 59.6% of all cases (39.3–83.3%) among adults age 25 + y globally. Low intake of whole grains (3.6 million cases (3.4–3.8)) followed by high intake of SSBs (2.7 million cases (2.5–2.9)) had the largest estimated attributable burdens. Across 7 world regions, highest diet-attributable burdens of T2D were in High Income Countries (2516 cases per million (2115, 2870)) and Former Soviet Union (2341 cases per million (1465, 2970)); and lowest in Sub-Saharan Africa (797 cases per million (333, 1435)). The proportion of T2D attributable to suboptimal diet was generally greater in males vs. females and in younger vs. older age groups. Results for specific countries, trends over time, and further sensitivity analyses will be presented. Conclusions These novel findings provide the most updated estimates of diet-attributable T2D globally, helping to inform priorities for targeted healthcare system, policy, industry and public health interventions to reduce T2D. Funding Sources Gates Foundation.

scholarly journals Cost-effectiveness of Community-Based Depression Interventions for Rural and Urban Adults With Type 2 Diabetes: Projections From Program ACTIVE (Adults Coming Together to Increase Vital Exercise) II

2021 ◽  
Author(s):  
Shihchen Kuo ◽  
Wen Ye ◽  
Mary de Groot ◽  
Chandan Saha ◽  
Jay H. Shubrook ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Behavioral Therapy ◽  
Intervention Strategy ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Healthcare Sector ◽  
Community Based

<b>Objective: </b>We estimated the cost-effectiveness of the Program ACTIVE II community-based exercise (EXER), cognitive behavioral therapy (CBT), and EXER+CBT interventions in adults with type 2 diabetes and depression relative to UC and each other. <p><b>Research Design and Methods: </b>Data were integrated into the Michigan Model for Diabetes to estimate cost and health outcomes over a 10-year simulation time horizon from the healthcare sector and societal perspectives, discounting costs and benefits at 3% annually. Primary outcome was cost per quality-adjusted life-year (QALY) gained.</p> <p><b>Results</b>: From the healthcare sector perspective, the EXER intervention strategy saved $313 per patient and produced 0.38 more QALY (cost-saving), the CBT intervention strategy cost $596 more and gained 0.29 more QALY ($2,058/QALY), and the EXER+CBT intervention strategy cost $403 more and gained 0.69 more QALY ($585/QALY) compared to UC. Both EXER and EXER+CBT interventions dominated the CBT intervention. Compared to EXER, the EXER+CBT intervention strategy cost $716 more and gained 0.31 more QALY ($2,323/QALY). From the societal perspective, compared to UC, the EXER intervention strategy saved $126 (cost-saving), the CBT intervention strategy cost $2,838/QALY, and the EXER+CBT intervention strategy cost $1,167/QALY. Both EXER and EXER+CBT interventions still dominated the CBT intervention. Compared to EXER, the EXER+CBT intervention strategy cost $3,021/QALY. Results were robust in sensitivity analyses.</p> <p><b>Conclusions: </b>All three Program ACTIVE II interventions represented a good value for money compared to UC. The EXER+CBT intervention was highly cost-effective or cost-saving compared to the CBT or EXER interventions.</p>

scholarly journals The impact of lung function on cardiovascular diseases and cardiovascular risk factors: a two sample bi-directional Mendelian randomization study

2020 ◽  
Author(s):  
SL Au Yeung ◽  
MC Borges ◽  
DA Lawlor ◽  
CM Schooling
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Lung Function ◽  
Mendelian Randomization ◽  
Sensitivity Analyses ◽  
Summary Statistics ◽  
The Impact ◽  
Genetic Instruments

AbstractBackgroundObservational studies suggested lung function is inversely associated with cardiovascular disease (CVD) although these studies could be susceptible to residual confounding. We conducted a 2 sample Mendelian randomization study using summary statistics from genome wide association studies (GWAS) to clarify the role of lung function in CVD and its risk factors, and conversely the role of CVD in lung function.MethodsWe obtained genetic instruments for forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) from publicly available UK Biobank summary statistics (n = 421,986). We applied these genetic instruments for FEV1 (260) and FVC (320) to publicly available GWAS summary statistics for coronary artery disease (CAD) (n = 184,305), stroke and its subtypes (n = 446,696), atrial fibrillation (n = 1,030,836), and heart failure (n = 977,320) and cardiovascular risk factors. Inverse variance weighting was used to assess the impact of lung function on these outcomes. Sensitivity analyses included MR-Egger, weighted median, MR-PRESSO, and multivariable Mendelian randomization. We also conducted bi-directional Mendelian randomization to assess whether CVD affects lung function.ResultsFEV1 and FVC were inversely associated with CAD (odds ratio (OR) per standard deviation (SD) increase, 0.72 (95% confidence interval (CI) 0.63 to 0.82) and 0.70 (95%CI 0.62 to 0.78)), overall stroke (0.87 (95%CI 0.77 to 0.97), 0.90 (0.82 to 1.00)), ischemic stroke (0.87 (95%CI 0.77 to 0.99), 0.90 (95%CI 0.80 to 1.00)), small vessel stroke (0.78, (95%CI 0.61 to 1.00), 0.74 (95%CI 0.61 to 0.92)), and large artery stroke (0.69 (95%CI 0.54 to 0.89), 0.72 (95%CI 0.57 to 0.91)). FEV1 and FVC were inversely associated with type 2 diabetes (0.75 (95%CI 0.62 to 0.90), 0.67 (95%CI 0.58 to 0.79)) and systolic blood pressure. Sensitivity analyses produced similar direction for most outcomes although the magnitude sometimes differed. Adjusting for height attenuated results for CAD (e.g. OR for 1SD FEV1 0.95 (0.76 to 1.20), but this may reflect weak instrument bias. This adjustment did not attenuate effects for stroke or type 2 diabetes. No strong evidence was observed for CVD affecting lung function.ConclusionHigher lung function likely protect against CAD and stroke.

Cost–effectiveness of empagliflozin versus weekly semaglutide as add-on therapy for Type 2 diabetes

2021 ◽  
Vol 10 (15) ◽  
pp. 1133-1141
Author(s):  
Margaret F Zupa ◽  
Ronald A Codario ◽  
Kenneth J Smith
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cost Effectiveness ◽  
Quality Adjusted Life Year ◽  
Complication Rates ◽  
Usual Treatment ◽  
Markov Decision Model ◽  
The Impact ◽  
Quality Adjusted Life

Aim: Perform a cost–effectiveness analysis of addition of subcutaneous semaglutide versus empagliflozin to usual treatment for patients with Type 2 diabetes and cardiovascular disease in US setting. Materials & methods: A Markov decision model estimated the impact of each strategy using cardiovascular complication rates based on EMPA-REG and SUSTAIN-6 trials. Modeled cohorts were followed for 3 years at 1-month intervals beginning at age 66. Results: Compared with empagliflozin, semaglutide resulted in cost of US$19,964 per quality-adjusted life-year gained. In one-way sensitivity analysis, only semaglutide cost >US$36.25/day (base case US$18.04) resulted in empagliflozin being preferred at a willingness-to-pay threshold of US$50,000/quality-adjusted life-year gained. Conclusion: For patients with Type 2 diabetes and cardiovascular disease, semaglutide is likely more cost-effective than empagliflozin added to usual treatment.

scholarly journals Cost-effectiveness of Community-Based Depression Interventions for Rural and Urban Adults With Type 2 Diabetes: Projections From Program ACTIVE (Adults Coming Together to Increase Vital Exercise) II

2021 ◽  
Author(s):  
Shihchen Kuo ◽  
Wen Ye ◽  
Mary de Groot ◽  
Chandan Saha ◽  
Jay H. Shubrook ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Behavioral Therapy ◽  
Intervention Strategy ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Healthcare Sector ◽  
Community Based

<b>Objective: </b>We estimated the cost-effectiveness of the Program ACTIVE II community-based exercise (EXER), cognitive behavioral therapy (CBT), and EXER+CBT interventions in adults with type 2 diabetes and depression relative to UC and each other. <p><b>Research Design and Methods: </b>Data were integrated into the Michigan Model for Diabetes to estimate cost and health outcomes over a 10-year simulation time horizon from the healthcare sector and societal perspectives, discounting costs and benefits at 3% annually. Primary outcome was cost per quality-adjusted life-year (QALY) gained.</p> <p><b>Results</b>: From the healthcare sector perspective, the EXER intervention strategy saved $313 per patient and produced 0.38 more QALY (cost-saving), the CBT intervention strategy cost $596 more and gained 0.29 more QALY ($2,058/QALY), and the EXER+CBT intervention strategy cost $403 more and gained 0.69 more QALY ($585/QALY) compared to UC. Both EXER and EXER+CBT interventions dominated the CBT intervention. Compared to EXER, the EXER+CBT intervention strategy cost $716 more and gained 0.31 more QALY ($2,323/QALY). From the societal perspective, compared to UC, the EXER intervention strategy saved $126 (cost-saving), the CBT intervention strategy cost $2,838/QALY, and the EXER+CBT intervention strategy cost $1,167/QALY. Both EXER and EXER+CBT interventions still dominated the CBT intervention. Compared to EXER, the EXER+CBT intervention strategy cost $3,021/QALY. Results were robust in sensitivity analyses.</p> <p><b>Conclusions: </b>All three Program ACTIVE II interventions represented a good value for money compared to UC. The EXER+CBT intervention was highly cost-effective or cost-saving compared to the CBT or EXER interventions.</p>

scholarly journals Insulin resistance and outcome in bipolar disorder

2015 ◽  
Vol 206 (1) ◽  
pp. 52-57 ◽  
Author(s):  
Cynthia V. Calkin ◽  
Martina Ruzickova ◽  
Rudolf Uher ◽  
Tomas Hajek ◽  
Claire M. Slaney ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Bipolar Disorder ◽  
Fasting Glucose ◽  
Clinical Course ◽  
Lithium Treatment ◽  
Sensitivity Analyses ◽  
The Impact ◽  
Chronic Course

BackgroundLittle is known about the impact of insulin resistance on bipolar disorder.AimsTo examine the relationships between insulin resistance, type 2 diabetes and clinical course and treatment outcomes in bipolar disorder.MethodWe measured fasting glucose and insulin in 121 adults with bipolar disorder. We diagnosed type 2 diabetes and determined insulin resistance. The National Institute of Mental Health Life Chart was used to record the course of bipolar disorder and the Alda scale to establish response to prophylactic lithium treatment.ResultsPatients with bipolar disorder and type 2 diabetes or insulin resistance had three times higher odds of a chronic course of bipolar disorder compared with euglycaemic patients (50% and 48.7% respectively v. 27.3%, odds ratio (OR) = 3.07, P = 0.007), three times higher odds of rapid cycling (38.5% and 39.5% respectively v. 18.2%, OR = 3.13, P = 0.012) and were more likely to be refractory to lithium treatment (36.8% and 36.7% respectively v. 3.2%, OR = 8.40, P<0.0001). All associations remained significant after controlling for antipsychotic exposure and body mass index in sensitivity analyses.ConclusionsComorbid insulin resistance may be an important factor in resistance to treatment in bipolar disorder.

GM Diabetes My Way: Digital interventions supporting self-care in people with type 2 diabetes across Greater Manchester. A study Protocol. (Preprint)

2020 ◽  
Author(s):  
Joanna Goldthorpe ◽  
Thomas Allen ◽  
Joanna Brooks ◽  
Evangelos Kontopantelis ◽  
Fiona Holland ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Decision Making ◽  
Diabetes Management ◽  
Personal Health Record ◽  
Economic Benefits ◽  
Self Management ◽  
Test Bed ◽  
Digital Interventions ◽  
The Impact

BACKGROUND Digital diabetes management systems have the potential to deliver cost-effective self-management support. DiabetesMyWay (DMW) is a platform for an open access website that includes a variety of multimedia resources including offering patients access to their clinical data in the form of an electronic personal health record. DMW aims to improve both the outcomes and experience of people with T2D, and provide them with a single care record which can be shared with their clinicians to support consultations, clinical decision making, care planning and self-management advice. OBJECTIVE The objective of this study is to evaluate the effectiveness of DMW and to explore acceptability to patients and clinicians METHODS A consensus approach to recruitment will be taken; all adults registered with type 2 diabetes, registered with a GP in the study area will be eligible. We will take a mixed methods approach to data collection analysis. RESULTS The primary outcome for effectiveness will be HbA1c value post intervention in participants and controls receiving usual care; a qualitative exploration of acceptability and a cost effectiveness evaluation. CONCLUSIONS Digital interventions have potential to transform self-management of T2D and deliver major clinical, psychological and economic benefits. This test bed project aims to assess the impact of a range of digital interventions delivered through DiabetesMyWay in an ethnically and socially diverse group of people with type two diabetes in Greater Manchester.

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