Mounié Michael, Costa Nadège, Gourdy Pierre, Latorre Christelle, Schirr-Bonnans Solène, Lagarrigue Jean-Marc, Roussel Henri, Martini Jacques, Buisson Jean-Christophe, Chauchard Marie-Christine, Delaunay Jacqueline, Taoui Soumia, Poncet Marie-France, Cosma Valeria, Lablanche Sandrine, Coustols-Valat Magali, Chaillous Lucie, Thivolet Charles, Sanz Caroline, Penfornis Alfred, Lepage Benoît, Colineaux Hélène, Hanaire Hélène, Molinier Laurent, Turnin Marie-Christine
Health-Economic Unit, Medical Information Department, University Hospital, Toulouse, France.
CERPOP, INSERM - University Toulouse III Paul Sabatier, Toulouse, France.
Diabetes Ther. 2022 Apr;13(4):693-708. doi: 10.1007/s13300-022-01207-1. Epub 2022 Feb 8.
Telemedicine programs using health technological innovation to remotely monitor the lifestyles of patients with type 2 diabetes (T2D) can improve glycaemic control and thus reduce the incidence of complications as well as management costs. In this context, an assessment was made of the 1-year and 2-year cost-effectiveness of the EDUC@DOM telemonitoring and tele-education program.
The EDUC@DOM study was a multicentre randomized controlled trial conducted between 2013 and 2017 that compared a telemonitoring group (TMG) to a control group (CG) merged with health insurance databases to extract economic data on resource consumption. Economic analysis was performed from the payer perspective, and direct costs and indirect costs were considered. The clinical outcome used was the intergroup change in glycated haemoglobin (HbA1c) levels from baseline. Missing economic data were imputed using multiple imputation, and fitted values from a generalized linear mixed model were used to calculate the incremental cost-effectiveness ratio (ICER). Bootstrapped 95% confidence ellipses were drawn in the cost-effectiveness plan.
The main analysis included data from 256 patients: 126 in the TMG and 130 in the CG. Incremental costs over 1 and 2 years were equal to €2129 and €5101, respectively, in favour of the TMG. Once imputed and adjusted for confounding factors, the TMG trends to a 21% cost decrease over 1 and 2 years of follow-up (0.79 [0.58; 1.08], p = 0.1452 and 0.79 [0.61; 1.03], p = 0.0879, respectively). The EDUC@DOM program led to a €1334 cost saving and a 0.17 decrease in HbA1c over 1 year and a €3144 cost saving and a 0.14 decrease in HbA1c over 2 years. According to the confidence ellipse, EDUC@DOM was a cost-effective strategy.
This study provides additional economic information on telemonitoring and tele-education programs to enhance their acceptance and promote their use. In the light of this work, the EDUC@DOM program is a cost-saving strategy in T2D management.
This trial was registered in the Clinical Trials Database on 27 September 2013 under no. NCT01955031 and bears ID-RCB no. 2013-A00391-44.
利用健康技术创新对2型糖尿病（T2D）患者的生活方式进行远程监测的远程医疗项目，可以改善血糖控制，从而降低并发症的发生率和管理成本。在此背景下，对EDUC@DOM远程监测和远程教育项目的1年和2年成本效益进行了评估。
EDUC@DOM研究是一项多中心随机对照试验，于2013年至2017年进行，将远程监测组（TMG）与对照组（CG）进行比较，并与健康保险数据库合并以提取资源消耗的经济数据。经济分析从支付方角度进行，同时考虑了直接成本和间接成本。所使用的临床结局是糖化血红蛋白（HbA1c）水平从基线开始的组间变化。缺失的经济数据采用多重填补法进行估算，并使用广义线性混合模型的拟合值来计算增量成本效益比（ICER）。在成本效益平面图中绘制了自抽样的95%置信椭圆。
主要分析纳入了256例患者的数据：TMG组126例，CG组130例。1年和2年的增量成本分别为2129欧元和5101欧元，有利于TMG组。在对混杂因素进行估算和调整后，TMG组在1年和2年的随访中成本有下降21%的趋势（分别为0.79[0.58；1.08]，p = 0.1452和0.79[0.61；1.03]，p = 0.0879）。EDUC@DOM项目在1年内节省了1334欧元的成本，HbA1c下降了0.17，在2年内节省了3144欧元的成本，HbA1c下降了0.14。根据置信椭圆，EDUC@DOM是一种具有成本效益的策略。
本研究提供了关于远程监测和远程教育项目的额外经济信息，以提高它们的可接受性并促进其使用。根据这项研究工作，EDUC@DOM项目是T2D管理中的一种成本节约策略。
本试验于2013年9月27日在临床试验数据库中注册，编号为NCT01955031，ID-RCB编号为2013-A00391-44。
