HIS modelling and simulation based cost-benefit analysis of a telemedical system for closed-loop diabetes therapy

OBJECTIVES INCA (Intelligent Control Assistant for Diabetes) is an EU funded project aimed at improving diabetes therapy by creating a personal closed-loop system interacting with telemedical remote control. This study aims at identifying and applying suitable methods for a cost-benefit analysis from the perspective of the payor for health services. METHODS For cost analysis MOSAIK-M was used, a method and tool for health information systems analysis and design. Two MOSAIK-M models were created describing conventional insulin pump based diabetes care (CSII), and INCA based diabetes care. Both models were parameterized with costs and simulated to determine yearly costs of diabetes management and treatment for a patient with no diabetes related complications. Probability of developing complications and their duration were determined based on the Archimedes model. It was parameterized with results of a clinical study concerning HbA1c-value changes using the INCA system compared with conventional CSII. The simulation results in form of years of disease within a 30-year time frame were multiplied with corresponding treatment costs. RESULTS Yearly costs of conventional insulin CSII for a diabetes type 1 patient are euro 5908 (German health care system). Using INCA based on the clinical study setting would raise yearly costs by euro 2233. 24% of the INCA costs are generated by the continuous blood glucose measurement device, 5% by IT devices and services. Considering also diabetes related complications in a 30-year time frame and HbA1c value reductions from 7.9 and 7.6% (conventional CSII) to 7.5 and 7.3% (INCA) reduces the additional costs of INCA to euro 2102 and euro 2162. CONCLUSIONS The approach produces an estimation of a lower bound for cost savings concerning the treatment of diabetes related complications in a 30-year time frame. These savings alone do not prove cost efficiency of the INCA approach. Further work is needed to improve the approximation and to include indirect and intangible costs.

[1]  David Hailey,et al.  The need for cost-effectiveness studies in telemedicine , 2005, Journal of telemedicine and telecare.

[2]  Ivar Jacobson,et al.  The unified modeling language reference manual , 2010 .

[3]  Francisco del Pozo,et al.  New trends in diabetes management: mobile telemedicine closed-loop system. , 2004, Studies in health technology and informatics.

[4]  R. Roine,et al.  Assessing telemedicine: a systematic review of the literature. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[5]  Enrique J. Gómez,et al.  Telemedicine as a tool for intensive management of diabetes: the DIABTel experience , 2002, Comput. Methods Programs Biomed..

[6]  L. Tarassenko,et al.  A systematic review of telemedicine interventions to support blood glucose self‐monitoring in diabetes , 2005, Diabetic medicine : a journal of the British Diabetic Association.

[7]  Penny Jennett,et al.  The need for economic evaluation of telemedicine to evolve: the experience in Alberta, Canada. , 2004, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[8]  David M. Eddy,et al.  Archimedes: a new model for simulating health care systems--the mathematical formulation , 2002, J. Biomed. Informatics.

[9]  J. Davidson.  Treatment of the patient with diabetes: importance of maintaining target HbA1c levels , 2004, Current medical research and opinion.

[10]  Roman Hovorka,et al.  Closing the loop: the adicol experience. , 2004, Diabetes technology & therapeutics.

[11]  T. Reardon,et al.  Research findings and strategies for assessing telemedicine costs. , 2005, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[12]  S. Roze,et al.  Health‐economic comparison of continuous subcutaneous insulin infusion with multiple daily injection for the treatment of Type 1 diabetes in the UK , 2005 .

[13]  J Hjelmgren,et al.  Health economic guidelines--similarities, differences and some implications. , 2001, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[14]  D. Hailey,et al.  Systematic review of evidence for the benefits of telemedicine , 2002, Journal of telemedicine and telecare.

[15]  D. Hailey,et al.  Study quality and evidence of benefit in recent assessments of telemedicine , 2004, Journal of telemedicine and telecare.

[16]  T. Klose.  A utility-theoretic model for QALYs and willingness to pay. , 2003, Health economics.

[17]  Volker Foos,et al.  The CORE Diabetes Model: Projecting Long-term Clinical Outcomes, Costs and Costeffectiveness of Interventions in Diabetes Mellitus (Types 1 and 2) to Support Clinical and Reimbursement Decision-making , 2004, Current medical research and opinion.

[18]  Kim Dunn,et al.  Outcomes and methods in telemedicine evaluation. , 2003, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[19]  Rüdiger Valk,et al.  Petri nets for systems engineering - a guide to modeling, verification, and applications , 2010 .

[20]  T. L. Williams,et al.  Systematic review of cost effectiveness studies of telemedicine interventions , 2002, BMJ : British Medical Journal.

[21]  Richard E. Scott,et al.  Moving research into practice: A decision framework for integrating home telehealth into chronic illness care , 2006, Int. J. Medical Informatics.

[22]  David M Eddy,et al.  Validation of the archimedes diabetes model. , 2003, Diabetes care.

[23]  H. Hauner,et al.  The cost burden of diabetes mellitus: the evidence from Germany—the CoDiM Study , 2006, Diabetologia.

[24]  A Winter,et al.  Modeling Hospital Information Systems (Part 2): using the 3LGM2 tool for modeling patient record management. , 2004, Methods of information in medicine.

[25]  M Stefanelli,et al.  The M2DM Project--the experience of two Italian clinical sites with clinical evaluation of a multi-access service for the management of diabetes mellitus patients. , 2006, Methods of information in medicine.

[26]  J W Cameron,et al.  Simulation methodology for estimating financial effects of telemedicine in West Virginia. , 1998, Telemedicine journal : the official journal of the American Telemedicine Association.

[27]  Rashid Bashshur,et al.  Telemedicine and the academic health center: the University of Michigan health system model. , 2005, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[28]  Stefan V. Pantazi,et al.  Success factors for telehealth - A case study , 2006, Int. J. Medical Informatics.