JMIR Publications

ABSTRACT

Background:

Type 2 diabetes mellitus (T2DM) is a chronic disease that requires management of blood glucose. The Dario Digital Diabetes Solution (DDS) is a non prescription digital health intervention with a smartphone app that previous studies have shown to improve blood glucose control in adults with T2DM.

Objective:

The aim of the study was to investigate the effects of DDS on healthcare resource utilization (HCRU) rates, charges, and estimated costs for adults with T2DM.

Methods:

In a retrospective cohort study, patient-level claims data of adults with T2DM were obtained from the Symphony Health Integrated Dataverse, a database containing both inpatient and outpatient claims including diagnoses and procedures. Using exact- and propensity score-matching, DDS users and non-users were matched in a 1:3 ratio. For the primary outcome measure (all-cause HCRU rates [defined as inpatient hospitalization and emergency room visits]) and secondary outcome measures (all-cause outpatient visit rates, all-cause HCRU charges, diabetes mellitus-related HCRU rates and charges) baseline, follow-up and change in values were summarized using descriptive statistics and a multivariable generalized linear model (GLM) or a 2-part model (including a GLM) was applied. Additional exploratory outcome measures were analyzed. In a sensitivity analysis, a cost-to-charge ratio (CCR) was calculated and applied to medical claims to estimate medical costs.

Results:

Following matching, cohorts consisted of 2445 DDS users and 7334 non-users with similar baseline characteristics and demographics. The all-cause HCRU event rate was 9.3% lower in DDS users compared with non-users in the 12-month follow-up from the index date. The mean number of events was estimated to be significantly lower in DDS users (0.48, 95% CI 0.44-0.52) per patient per year [PPPY]) than non-users (0.52 PPPY, 95% CI 0.50-0.55), resulting in an incidence rate ratio of 0.91 (P=.04). Inpatient hospitalization was 23.5% lower in the DDS user cohort compared with the non-user cohort, with emergency room visit and outpatient visit rates being similar across both cohorts. DDS users were numerically less likely to incur all-cause HCRU charges than non-users (odds ratio 0.91; 95% CI 0.82-1.01; P=.07). All-cause HCRU charges were 26% lower for DDS users than for non-users ($12,552 PPPY savings; P<.001). When applying the CCR to the charges, the total estimated cost saving for DDS users was $5077, of which $4513 PPPY was attributed to all-cause HCRU and $564 to all-cause office visits.

Conclusions:

In a retrospective cohort study of adults in the US with T2DM, DDS users were found to have lower all-cause HCRU rates than non users, driven by significantly lower inpatient hospitalization. All-cause HCRU charges and estimated costs were shown to be lower for DDS users compared with non-users.