Clinical and Economic Impact of a Digital, Remotely-Delivered Intensive Behavioral Counseling Program on Medicare Beneficiaries at Risk for Diabetes and Cardiovascular Disease

PLoS One. 2016 Oct 5;11(10):e0163627. doi: 10.1371/journal.pone.0163627. eCollection 2016.

Abstract

Background: Type 2 diabetes and cardiovascular disease impose substantial clinical and economic burdens for seniors (age 65 and above) and the Medicare program. Intensive Behavioral Counseling (IBC) interventions like the National Diabetes Prevention Program (NDPP), have demonstrated effectiveness in reducing excess body weight and lowering or delaying morbidity onset. This paper estimated the potential health implications and medical savings of a digital version of IBC modeled after the NDPP.

Methods and findings: Participants in this digital IBC intervention, the Omada program, include 1,121 overweight or obese seniors with additional risk factors for diabetes or heart disease. Weight changes were objectively measured via participant use of a networked weight scale. Participants averaged 6.8% reduction in body weight within 26 weeks, and 89% of participants completed 9 or more of the 16 core phase lessons. We used a Markov-based microsimulation model to simulate the impact of weight loss on future health states and medical expenditures over 10 years. Cumulative per capita medical expenditure savings over 3, 5 and 10 years ranged from $1,720 to 1,770 (3 years), $3,840 to $4,240 (5 years) and $11,550 to $14,200 (10 years). The range reflects assumptions of weight re-gain similar to that seen in the DPP clinical trial (lower bound) or minimal weight re-gain aligned with age-adjusted national averages (upper bound). The estimated net economic benefit after IBC costs is $10,250 to $12,840 cumulative over 10 years. Simulation outcomes suggest reduced incidence of diabetes by 27-41% for participants with prediabetes, and stroke by approximately 15% over 5 years.

Conclusions: A digital, remotely-delivered IBC program can help seniors at risk for diabetes and cardiovascular disease achieve significant weight loss, reduces risk for diabetes and cardiovascular disease, and achieve meaningful medical cost savings. These findings affirm recommendations for IBC coverage by the U.S. Preventive Services Task Force.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / economics
  • Cardiovascular Diseases / prevention & control*
  • Cost-Benefit Analysis
  • Counseling
  • Diabetes Mellitus, Type 2 / economics
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Female
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Male
  • Markov Chains
  • Medicare
  • Models, Theoretical
  • Remote Consultation / methods*
  • Risk Factors
  • United States
  • Weight Reduction Programs / methods*

Substances

  • Hypoglycemic Agents

Grant support

Funding for this study was provided by Omada Health, Inc, who provided raw data for analysis and participated in preparation of this manuscript. M.P. and C.M.C.S. are employees of the study sponsor. F.C., W.S., T.M.D., and S.H.B. provide paid consulting services to the study sponsor for this and other research. A.L.P. reports no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. The study sponsor approved the study design developed by T.M.D., F.C., and W.S. Data provided by study sponsor was analyzed solely by F.C. All authors of this manuscript, with the exception of Dr. Anne L. Peters, contributed to interpretation of study findings and draft of the manuscript. A.L.P. provided critical comments to the intellectual content of manuscript.