Self-monitoring of type 2 diabetes cuts follow-up costs by more than half

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Self-monitoring of type 2 diabetes used in combination with an electronic feedback system results in considerable savings on health care costs especially in sparsely populated areas, a study from the University of Eastern Finland shows.

Self-monitoring delivers considerable savings on the overall costs of type 2 diabetes care, as well as on patients’ travel costs. Glycated haemoglobin testing is an important part of managing diabetes, and also a considerable cost item. By replacing half of the required follow-up visits with self-measurements and electronic feedback, the annual total costs of glycated haemoglobin monitoring were reduced by nearly 60%, bringing the per-patient cost down from €280 ($300) to €120 ($130). With fewer follow-up visits required, the average annual travel costs of patients were reduced over 60%, from €45 ($48) to €17 ($18) per patient.

Carried out in the region of North Karelia in Finland, the study applies geographic information systems (GIS)-based geospatial analysis combined with patient registers.

This was the first time the costs of type 2 diabetes follow-up were systematically calculated over a health care district in Finland. The study analysed 9,070 patients diagnosed with type 2 diabetes. Combined travel and time costs amount to 21 per cent of the total costs of glycated haemoglobin monitoring for patients with type 2 diabetes.

“The societal cost-efficiency of type 2 diabetes care could be improved in by taking into consideration not only the direct costs of glycated haemoglobin monitoring, but also the indirect costs, such as patients’ travel costs,” researcher Aapeli Leminen from the University of Eastern Finland says.

The study used a geo-referenced cost model to analyse health care accessibility and different costs associated with the follow-up of type 2 diabetes. Patients’ travel and time costs were analysed by looking at how well health care services could be reached on foot or by bike, or by using a private car, a bus, or a taxi. According to Leminen, the combination of patient registers and GIS opens up new opportunities for research within the health care sector.

“This cost model we’ve now tested in the eastern part of Finland can easily be used in other places as well to calculate the costs of different diseases, such as cancer and cardiovascular diseases.”

Background: Type 2 diabetes (T2DM) is a major health concern in most regions. In addition to direct healthcare costs, diabetes causes many indirect costs that are often ignored in economic analyses. Patients’ travel and time costs associated with the follow-up of T2DM patients have not been previously calculated systematically over an entire healthcare district. The aim of the study was to develop a georeferenced cost model that could be used to measure healthcare accessibility and patient travel and time costs in a sparsely populated healthcare district in Finland. Additionally, the model was used to test whether savings in the total costs of follow-up of T2DM patients are achieved by increasing self-monitoring and implementing electronic feedback practices between healthcare staff and patients.
Methods: Patient data for this study was obtained from the regional electronic patient database Mediatri. A georeferenced cost model of linear equations was developed with ESRI ArcGIS 10.3 software and ModelBuilder tool. The Model utilizes OD Cost Matrix method of network analysis to calculate optimal routes for primary-care follow-up visits.
Results: In the study region of North Karelia, the average annual total costs of T2DM follow-up screening of HbA1c (9070 patients) conforming to the national clinical guidelines are 280 EUR/297 USD per patient. Combined travel and time costs are 21 percent of the total costs. Implementing self-monitoring for a half of the follow-up still within the guidelines, the average annual total costs of HbA1c screening could be reduced by 57 percent from 280 EUR/297 USD to 121 EUR/129 USD per patient.
Conclusions: Travel costs related to HbA1c screening of T2DM patients constitute a substantial cost item, the consideration of which in healthcare planning would enable the societal cost-efficiency of T2DM care to be improved. Even more savings in both travel costs and healthcare costs of T2DM can be achieved by utilizing more self-monitoring and electronic feedback practices. Additionally, the cost model composed in the study can be developed and expanded further to address other healthcare processes and patient groups.

Aapeli Leminen, Markku Tykkyläinen and Tiina Laatikainen

University of Eastern Finland material
International Journal of Medical Informatics abstract

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