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Diabetes Management Blood Glucose Monitoring Deployment of an mHealth Patient Monitoring Solution for Diabetes— Improved Glucose Monitoring Leads to Reduction in Medical Expenditure Jonathan C Javitt, MD, MPH, 1 C Shane Reese, PhD 2 and Michael K Derrick, BA 3 1. Adjunct Professor, School of Medicine, Johns Hopkins University, Baltimore, Maryland, US; 2. Professor, Department of Statistics, Brigham Young University, Provo, Utah, US; 3. Research Assistant, Department of Mathematics, Brigham Young University, Provo, Utah, US Abstract Although there is ample evidence that improved glucose control prevents long-term complications of diabetes, few reports have addressed the effect of improved control on short-term healthcare costs. Methods: A mobile health (mHealth)-enabled glucose meter combined with a disease management call center was deployed in 143 employees as part of an employer-sponsored diabetes disease management intervention. The program cost was approximately $50 per member per month over and above the cost of standard care. Results: Overall, on an intention-to-treat basis, this program was associated with an annual reduction of $1,595 (95% confidence interval [CI] –$2,827 to +$181) per person in incurred medical claims. A subanalysis documented that those who actively participated in the program (50 %) incurred a year-over-year claims cost decrease of $3,384 (95 % CI $643 to $5,149) compared with an increase of $282 among those who did not participate. Conclusions: These findings suggest that even partial improvement of diabetes testing adherence within an employed population may result in substantial attenuation of employee medical expense. The reduction in healthcare costs, even when considering those who did not comply, outweighed the program costs by several-fold. Keywords Diabetes, economics, wireless-health, glucose monitoring, cost-effectiveness Disclosure: Jonathan C Javitt, MD, MPH, is a shareholder and employee of Telcare, Inc. C Shane Reese, PhD, has served as a consultant to ActiveCare, Inc. Michael K Derrick, BA, is an employee and shareholder of ActiveCare, Inc. Received: October 31, 2013 Accepted: November 27, 2013 Citation: US Endocrinology 2013;9(2):119–23 Correspondence: Jonathan C Javitt, MD, MPH, 2 Bethesda Metro Center, Suite 1350, Bethesda, MD 20814, US. E: Support: The publication of this article was supported by Telcare, Inc. and ActiveCare, Inc. The preponderance of scientific evidence 1–3 suggests that monitoring and control of blood glucose prevents vascular complications of diabetes and, consequently, long-term medical costs associated with diabetes. 4–6 While this effect is widely believed to apply to long-term rather than near- term costs, Sokol and colleagues reported that better medication adherence in diabetes may result in an annual near-term cost reduction of $4,297 per person. 7 This methodology was used by the California Public Employees Retirement System to report that people with diabetes were noncompliant with care incurred $3,384 more in medical costs per year than those who were at least partially compliant. 8 Individuals with diabetes incur on average $13,700 per year in medical expenses, more than half ($7,900) of which is spent directly on treatment of diabetes and its complications. 6 While health insurers tend to focus on reimbursed medical expenditures associated with illness, employers are also faced with the effects of absenteeism, lost productivity, and worker replacement, currently estimated at $3,136 per person-year. The challenge facing the healthcare system is not whether to implement proper glucose monitoring and control, but rather how to motivate people with diabetes to monitor themselves. Behavior-change disease © TO U CH MEDICAL MED IA 2013 management (DM) programs have demonstrated efficacy in improving compliance with glucose monitoring and control in patients with diabetes. 9,10 One such program actually demonstrated a $3,000 per year increase in employee productivity, providing independent support for the American Diabetes Association (ADA) estimate. 7 However, the costs of traditional call center-based programs have hindered their widespread implementation. 11 In recent years there has been increasing recognition that advances in health information technology, particularly mobile health or ‘mHealth,’ solutions may be vital to the management and control of chronic illness. Initial studies with prototypes of wireless monitoring solutions have offered encouraging results. 12,13 Recent advances in cellular radio technology and health information technology have substantially altered this equation. In recent years, the first ‘postage stamp-sized’ cellular radio modules became commercially available, thus making it technologically feasible to insert cellular data transmission capability into a small, inexpensive consumer devices, such as a home-use glucose meter. This technologic advance enables the traditional DM call center to monitor a large population of patients in real time, similar to the manner in which burglar and fire alarms have been monitored for decades—with 119