How Could the VA Saves $500 Million Yearly Using Virtual Diabetes Therapy

Presentation Number: SAT 623
Date of Presentation: April 1st, 2017

Saad Sakkal*
Metabolic Care Center, Mason, OH

Abstract

Introduction: VA is the largest system in the country with 1.5 million vets with diabetes (25% of vets). Diabetes costs 6% of the VA’s budget ($67 billion) and 30% of its pharmacy budget. Yet, A1c < %7 is still elusive in 61%, with high burden of CVD. Poor glycemia (A1c>%9.2) is the main reason for referral (%75) to metabolic service.

Hypothesis: To establish better electronic support is effective approach in VA primary care. We analyzed past VA experience and estimated savings from using “Diabetes Computer Therapy for Optimum Control”.

Methods: reviewed all published reports on the VA Diabetes utilization and expenses since 1996.

Results: In 1996 VA began at least annual HbA1c, any poor glycaemia (A1c >10%) monitored by a monthly phone call. In 2004 the VA incurred $1.65 billion. The total pharmacy cost was 79% higher with diabetes. Annual costs were $1,010 per vet and highest for vets taking insulin and oral agents ($1,658). The A1c dropped from % 8.4 to 7.8.In the largest subgroup (oral agents) the mean A1c remained 7.6%. Since then medications expense and number of serviced vets has doubled. In 2010 comparing active care management, supported by home tele-monitoring (ACM+HT) transmitting Blood Glucose, BP, and Lipids, using Viterion 100 Monitor, with a monthly care telephone call, showed better decrease in A1c at 3 months (1.7 vs. 0.7).

In a recent landmark study (in 1,657.610 patient’s private insurance) it has been shown that since 2006, the use of drugs has changed dramatically with an increase for metformin, DPP-4I, and insulin, and decline for SU and TZD. Patients with A1c <7% surprisingly declined (from 56.4 to 54.2%) and A1c >9% increased (9.9 to12.2).Severe hypoglycemia remained at 1.3 per 100 person/yr.(3.5 per 1000 with> 2 comorbid conditions)

Computer Diabetes Therapy has been shown in “real life experience to improve A1C by % 2.7, decrease DCCT style expense by %70” and estimated to save VA care by % 30.Computer Diabetes therapy clinical outcomes has been extensively reported in N-Of-1 Trials. It duplicates DCCT result safely, cost effectively, without hypoglycemia or weight gain, with 90% compliance with present guidelines.

Interpretation: despite remarkable progress, the VA sorely needs cost effective system dealing with bigger challenges in 2017-20: 1) Projections from past data: The VA will care for at least 1.8 Million people with diabetes at yearly cost of $ 1800 per person with extra for comorbidities of another $3200/yr. or a total direct and indirect expense of $7-8 Billions/year.2) Good control in the last 10 years is still a challenge with % 60 of Vets still higher than %7 A1c goal, despite the use of more expensive drugs and consensus guidelines.3) Hypoglycemia rate has not improved in the last 10 years.

Conclusion: Only Computer Diabetes Therapy system has been proven to reverse the trend of increasing diabetes care expense and will save at least $ 0.5-1 Billion/yr. as shown in real life experience.

 

Nothing to Disclose: SS