LIVONIA, Mich., Jan. 25, 2018 /PRNewswire/ -- Hygieia, a digital insulin enhancement company dedicated to making insulin therapy easier for everyone involved, announced that the Journal of Health Economics and Outcomes Research published findings from a Health Economic Evaluation of the d-Nav® Insulin Guidance Service. The evaluation, conducted in collaboration with Blue Cross Blue Shield of Michigan (BCBSM), concluded that the d-Nav Service significantly improves insulin use among people with type 2 diabetes who use the Service, leading to substantial cost savings. A significant portion of these savings resulted from the review and optimization of combination therapy related to glycemic medications.
"Insulin therapy is critical to the health of more than 6 million people in the United States, but it is often ineffective, largely because it requires intensive management that can be extremely time-consuming," said Eran Bashan, Ph.D., Hygieia CEO. "This ineffectiveness leads to combination therapy with multiple glycemic medications, which increases the burden of treatment costs for patients, insurers and the healthcare system. The initial results from this evaluation add to evidence demonstrating that the d-Nav Service makes insulin therapy more effective and easier for everyone and, thereby, measurably reduces associated costs and improves patients' glycemic control."
Clinical practice guidelines generally point to hemoglobin A1c (HbA1c) levels below 7 percent as reasonable targets to help prevent diabetes complications. Standards for Medical Care in Diabetes published by the American Diabetes Association (ADA) state that for patients whose HbA1c is poorly controlled on a standard regimen of insulin plus metformin, treatment should be intensified by adding glycemic medications such as a DPP-4 inhibitor, SGLT-2 inhibitor or GLP-1 receptor agonist. The least expensive of these medications costs approximately $400 per month,1,2,3 and all are expected to reduce HbA1c by 0.5-1.5 percent.4
All participants in the d-Nav Service Health Economic Evaluation used the d-Nav Service, and a total of 192 patients with type 2 diabetes completed the first 90 days. Prior to joining the study, nearly 30 percent of participants had been prescribed expensive glycemic medications as part of their treatment regimen.* Initial results from the evaluation show that the d-Nav Service enables optimization of glycemic medications for most patients, reducing the need for multiple medications (i.e., poly-therapy), while also reducing HbA1c by an average of 1.7 percentage points within 90 days.
Medication Cost Savings: In line with ADA treatment algorithms, the d-Nav Service study protocol proposed that when patients had an improved HbA1c at their 90-day visit (compared to their baseline HbA1c), their use of hyperglycemic medications would be reviewed and optimized to reduce poly-therapy. Among all d-Nav Service study participants who completed the 90-day visit, 89 percent (170 of 192) were eligible for medication review based on improved HbA1c, resulting in a savings of nearly $1,800 per person per year. Among the 54 patients taking one or more expensive medications at baseline (the "target group"), 45 were eligible for medication review leading to prescription modifications, with an associated average savings of $6,172 per person per year after the 90-day period. For a health plan with 10,000 patients in this target group, the estimated annual savings from medication optimization alone would be nearly $62 million.
"The cost savings demonstrated in this evaluation are substantial," said John Schneider, Ph.D., CEO of Avalon Health Economics and the lead author of the publication. "They suggest that the d-Nav Service could be a better, less expensive alternative to the standard of care for type 2 diabetes, and could play an important role in reducing the economic and clinical impact of the disease in this country."
Improved Glycemic Control: The average HbA1c among all 192 d-Nav Service study participants was 9.4 percent at study initiation; the average HbA1c at participants' 90-day visit was 7.7 percent – an average HbA1c decrease of 1.7 percentage points. This HbA1c reduction is expected to further reduce medical costs by an additional $6,000 per person per year - over and above savings associated with optimizing glycemic-medication use. Importantly, more than half of the study participants had poorly controlled diabetes (i.e., an HbA1c greater than 9 percent) at baseline. More than 85 percent of these patient had HbA1c ≤9 percent at the 90-day mark, with an average 90-day HbA1c for this subgroup of 7.63 percent.
"The likelihood of people with type 2 diabetes experiencing severe complications such as heart disease, heart failure, stroke and blindness increases significantly for each one percent increase in HbA1c," said Dr. Jerome Frankel, chief medical officer at Oakland Southfield Physicians, and the primary investigator of the study. "In this evaluation, patients using the d-Nav Service reduced their HbA1c levels by nearly two percentage points over 90 days while also reducing their dependence on costly medications. These results are tremendously meaningful clinically and financially, for individual patients as well as the healthcare system."
Patient Satisfaction: Study participants also reported high satisfaction with the d-Nav Service overall. Among 103 study patients who responded to a blinded participant survey, all but one said that they are more satisfied with their ability to manage diabetes and all 103 reported being more satisfied with their blood sugar control while supported by the d-Nav Service.
Three-year data from a similar demonstration project conducted by The South Eastern Health and Social Care Trust (SEHSCT), part of the UK's National Health Service, showed that patients using the d-Nav Service experienced a significant drop in HbA1c - from 9.5 percent to approximately 7.25 percent - which was maintained for as long as patients were using the d-Nav Insulin Guidance Service. In 2015, SEHSCT became the first health system in the world to adopt the d-Nav Service as a new standard of care for patients with type 2 diabetes using insulin.
About the d-Nav Insulin Guidance Service
The Hygieia d-Nav Insulin Guidance Service combines smart cloud-based technology and a small team of healthcare professionals to support primary care physicians and help people with diabetes achieve improved health. The d-Nav Service provides personalized adjustments to enhance and simplify insulin dosing, maximizing its effectiveness for patients and the physicians who prescribe it. The d-Nav Service has demonstrated ability to sustain HbA1c reductions for at least three years.5
Hygieia is a digital insulin enhancement company dedicated to making insulin therapy easier for everyone involved. The company is based in Ann Arbor, Mich. and has a wholly owned subsidiary in Northern Ireland. More information is available at www.hygieia.com
About Blue Cross Blue Shield of Michigan
Blue Cross Blue Shield of Michigan, a nonprofit mutual insurance company, is an independent licensee of the Blue Cross and Blue Shield Association. BCBSM provides and administers health benefits to more than 4.5 million members residing in Michigan in addition to employees of Michigan-headquartered companies who reside outside the state. For more company information, visit bcbsm.com and MIBluesPerspectives.com.
* DPP-4 inhibitor, SGLT-2 inhibitor or GLP-1 receptor agonist
5 South Eastern Health and Care Trust (SEHCT). April 2016.