title: Clinical and Economic Impact of a Digital, Remotely-Delivered Intensive Behavioral Counseling Program on Medicare Beneficiaries at Risk for Diabetes and Cardiovascular Disease.
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.
  
  
  RESULTS
  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.
authors.affiliation: IHS Life Sciences, Washington, District of Columbia, United States of America.
authors.forename: Fang
authors.initials: F
authors.lastname: Chen
authors.affiliation: IHS Life Sciences, Washington, District of Columbia, United States of America.
authors.forename: Wenqing
authors.initials: W
authors.lastname: Su
authors.affiliation: Silvercat Advisors, LLC, Burlingame, California, United States of America.
authors.forename: Shawn H
authors.initials: SH
authors.lastname: Becker
authors.affiliation: Omada Health, Inc., San Francisco, California, United States of America.
authors.forename: Mike
authors.initials: M
authors.lastname: Payne
authors.affiliation: Omada Health, Inc., San Francisco, California, United States of America.
authors.forename: Cynthia M
authors.identifier: http://orcid.org/0000-0001-6860-4095
authors.initials: CM
authors.lastname: Castro Sweet
authors.affiliation: Keck School of Medicine of University of Southern California, Los Angeles, California, United States of America.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Peters
authors.affiliation: IHS Life Sciences, Washington, District of Columbia, United States of America.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Dall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003376:Counseling; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D006278:Medicare; D008962:Models, Theoretical; D019114:Remote Consultation / Q000379:methods*; D012307:Risk Factors; D014481:United States; D061217:Weight Reduction Programs / Q000379:methods*
chemical_list: D007004:Hypoglycemic Agents