Effects of a Digital Health Intervention for Adults With Type 2 Diabetes Mellitus on Health Care Resource Use and Health Care Charges in the United States: Retrospective Cohort Study.

backgroundType 2 diabetes mellitus (T2DM) is a chronic disease that requires management of blood glucose. According to previous studies, the Dario Digital Diabetes Solution (DDS) is a nonprescription digital health intervention with a smartphone app that has been shown to improve blood glucose control in adults with T2DM.

objectiveThis study aims to investigate the effects of DDS on health care resource use (HCRU) rates, charges, and estimated costs for adults with T2DM.

methodsIn this 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 nonusers 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, and diabetes mellitus-related HCRU rates and charges), baseline, follow-up, and changes in values were summarized using descriptive statistics, and a multivariable generalized linear model or a 2-part model (including a generalized linear model) was applied. Additional exploratory outcome measures were analyzed. In a sensitivity analysis, a cost-to-charge ratio was calculated and applied to medical claims to estimate medical costs.

resultsFollowing matching, cohorts consisted of 2445 DDS users and 7334 nonusers with similar demographic and baseline characteristics. The all-cause HCRU event rate was 9.3% lower in DDS users compared with nonusers at 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 per patient per year [PPPY]; 95% CI 0.44-0.52) than nonusers (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 nonuser 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 nonusers (odds ratio 0.91, 95% CI 0.82-1.01; P=.07). All-cause HCRU charges were 26% lower for DDS users than for nonusers (US $ 12,552 PPPY savings; P<.001). When applying the cost-charge-ratio to the charges, the total estimated cost saving for DDS users was US $5077, of which US $4513 PPPY was attributed to all-cause HCRU and US $564 to all-cause office visits.

conclusionsIn this retrospective cohort study of adults in the United States with T2DM, DDS users were found to have lower all-cause HCRU rates than nonusers, driven by significantly lower inpatient hospitalization rates (P<.001). All-cause HCRU charges and estimated costs were shown to be lower for DDS users compared with nonusers.