Objectives
Behavioral interventions produce meaningful improvements in glycemic control, lipid levels and hypertension in patients with metabolic and cardiovascular conditions. Digital therapeutics delivering these interventions have the potential to provide benefits comparable to pharmacologic therapies. At this point in development, however, there are few assessments of the potential economic benefits of digital therapeutics. We estimated the economic impact of a digital behavioral intervention in 3 patient populations: type 2 diabetes mellitus (DM), dyslipidemia (HC), and hypertension (HTN).
Methods
Decision-analytic models estimated budget impact and cost-effectiveness from a US commercial payer perspective. A 3-year time horizon was used as most relevant to the intervention and payer. Effectiveness of the digital therapeutic in improving clinical outcomes were based on cohort studies and the published literature. Resource utilization rates, health state utilities and costs were drawn from the literature with costs inflated to 2017 dollars. Costs and QALYs were discounted at 3%. Sensitivity analyses assessed uncertainty.
Results
Average savings in health resource utilization (HRU) ranged from $98 to $178 per patient per month, with the highest potential benefits in DM. QALY improvements were estimated at 0.0549 – 0.0918 in the 3 patient populations. Cost-effectiveness acceptability analyses using a willingness to pay threshold of $100,000/QALY indicated that the intervention would be cost-effective at total three-year program costs of $10,931, $11,553, and $6,443 for DM, HC, and HTN respectively. Sensitivity analyses showed that medication costs were the primary driver of potential HRU savings and that all results were robust within values tested. A resistance to deprescribe pharmacologic treatments when patients’ clinical outcomes improve can substantially reduce estimated economic benefits.
Conclusions
Digital therapeutics can provide substantial improvements in economic outcomes at much lower costs than comparable pharmacologic interventions. Clinical inertia may be a barrier to realizing the economic benefits of digital therapeutics.
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