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

Abstract

BackgroundBehavioral interventions can meaningfully improve cardiometabolic conditions. Digital therapeutics (DTxs) delivering these interventions may provide benefits comparable to pharmacologic therapies, displacing medications for some patients.ObjectiveOur 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.MethodsDecision 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.ResultsAverage 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.ConclusionsThe 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.

Cost-effectiveness of digital therapeutics for essential hypertension

“…35 Previous DTx studies for cost-effectiveness analyses also used similar attrition rates. 15,32 Thus, it could be reasonable to set the attrition rate of 25% every 6 months in this model, which half time was around 15 months since the initiation of DTx. In another scenario, when we changed the rate to 10% (lower than the predefined 25%), the half time exceeded approximately 40 months, and the ICER was increased to approximately ¥4.3 million/QALY in a lifetime horizon, which was close to the threshold value (Figure 2).…”

From Precision Metapharmacology to Patient Empowerment: Delivery of Self-Care Practices for Epilepsy, Pain, Depression and Cancer Using Digital Health Technologies

“…An increasing number of studies show clinical benefits of mobile and web-based apps, or therapeutic video games, in people with diabetes, substance use, depression, anxiety, schizophrenia and bipolar disorder, chronic pain, epilepsy, cardiovascular diseases, and cancer ( Sverdlov et al, 2018 ; Chung, 2019 ; Sin et al, 2020 ). Clinical benefits and cost-effectiveness of digital interventions favor their implementation into health care ( Jiang et al, 2019 ; Nordyke et al, 2019 ; Dang et al, 2020 ; Richards et al, 2020 ).…”

Effect of Digital Lifestyle Management on Metabolic Control and Quality of Life in Patients with Well-Controlled Type 2 Diabetes

“…Digital tools could potentially complement drug treatment and traditional lifestyle programmes, but most solutions require intensified healthcare activities or user fees, which preclude broad application. In light of the increasing number of afflicted individuals, it is necessary to find new means to support lifestyle self-management that can meet individual preferences in content and timing and reach many patients at low cost [2][3][4]. This is, however, currently hampered by several important knowledge gaps [5].…”