Digitalized secondary care services for insulin-dependent diabetes patients – Predictive cost-benefit analysis of Virtual Hospital 2.0 digital care path

Abstract

Background: Virtual hospital 2.0 (VH2.0, Virtuaalisairaala 2.0) platform, a joint project between all Finnish university hospitals [1] is an essential part of a key governmental wellbeing project of customer-responsive services in Finland [2–3]. VH2.0 produces and implements client-oriented digital special care services to various stakeholders (e.g. patients, providers) in Virtual village (Terveyskylä [4]). On national level, five-year cumulative potential health care capacity freed with VH2.0 was estimated at €1.3 billion [5]. Here, eHealth service (digital care path) for specific indication was assessed in terms of predictive cost-benefit analysis.

Aim: Predictive cost-benefit modelling of VH2.0 digital care path for insulin-dependent diabetes patients.

Methods: The health economic evaluation (HEE) considered clinical and economic viewpoints and was based on the PICOSTEPS principle, which reports the content of HEE in its order of importance [6]. PICOSTEPS has been used in e.g. the Finnish Current Care Criteria [7], real-world data (RWD) based [8] and modelled [6] HEEs.

Patients: All individuals with insulin-dependent diabetes who are expected to use specialized care services in 1) the Kuopio University Hospital Catchment Area (KUH ERVA) or 2) Finland generally. Intervention: Modelled VH2.0 operational change (prediction) with the examined digital care path including e.g. e-messages, e-appointments, a virtual meeting and material available for patients. Comparator: Modelled conventional practice (prediction) based on population and morbidity information and Finnish RWD. Outcome: Predicted health care capacity freed (PHCCF, year 2017 real value) at KUH ERVA and at Finnish national level available for other uses within the health care system, allowed by the digital care path.

Setting: Dynamic cost-benefit modelling covering the predicted changes in the patient cohorts based on the population structures and morbidity. Time: First five years from year 2018 to 2022 in annual cycles; assuming digital care path implementation was initiated in the beginning of year 2018 and completed gradually in three years at the KUH ERVA level and in four years at the national level. No discounting of PHCCF was done. Effects: Expected over-time changes in population structure and morbidity, resource use (e.g., clinician and nurse visits, letters and calls, inpatient days, e-appointments, e-messages, travelling, patient fees) and unit costs based on the RWD and expert information. Perspective: Third-party payer including only direct health care and travelling costs. Sensitivity analyses: The gradual implementation of digital care path in two or five years.

Results: At the KUH ERVA level, the average annual PHCCF with digital care path was estimated at €0.125 million for the first five years, summing up to total estimated five-year PHCCF of €0.626 million (27.5 % of the total included conventional practice costs). At the national Finnish level, average annual PHCCF with digital care path was estimated at €0.577 million for the first five years, summing up to total estimated five-year PHCCF of €2.89 million (23.2 % of the total included conventional practice costs). The five most important key value drivers for the PHCCF were physician visits, nurse visits, patient fees, travelling and nurse calls.

Conclusions: VH2.0 digital care path for insulin-dependent diabetes patients potentially frees substantial capacity for other purposes. From the perspective of opportunity costs such technological revolution is very valuable and the capacity freed can produce significant effectiveness elsewhere [9].

References:
[1] www.virtuaalisairaala2.fi [2] valtioneuvosto.fi/en/implementation-of-the-government-programme
[3] valtioneuvosto.fi/documents/10184/321857/Government+action+plan+28092017+en.pdf
[4] www.terveyskyla.fi/ [5] Väätäinen et al. Virtual hospital 2.0 – modelled cost-benefit assessment. eHealth2018. [6] Soini et al. ClinicoEconomics and Outcomes Research 2018;10:279–92.
[7] http://www.kaypahoito.fi/web/kh/suositukset/suositus?id=nix02465&suositusid=hoi50062
[8] Soini et al. Clinical Therapeutics 2017;39:537–57.e10. [9] Hallinen et al. Vaihtoehtoiskustannukset ja kustannusvaikuttavuus tuotantoteknologian muuttuessa: esimerkkinä eteisvärinän antikoagulaatiohoito. Terveystaloustiede 2012. Helsinki: THL, 69–73.