Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 8, 2019
Date Accepted: Sep 20, 2019
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Estimating the economic impact of novel digital therapeutics in type 2 diabetes and hypertension
ABSTRACT
Background:
Behavioral interventions can meaningfully improve cardiometabolic conditions. Digital therapeutics (DTx) 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 to estimate the impact of clinical inertia to 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 digital therapeutic 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 three-year program costs of $6,468 and $6,620 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 DTx and cannot account for other disease management programs that may be implemented. Performance of DTx in real-world settings is required to further validate their economic benefits.
Conclusions:
The digital therapeutics studied may provide substantial cost savings, in part by reducing the use of conventional medications. Clinical inertia may limit the full cost-savings of digital therapeutics. Clinical Trial: n/a
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.