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