- Could you please introduce yourself and your role in DigiCare4You?
My name is Delfien Gryspeerdt, I am a PhD researcher in health economics at Ghent University in Belgium. While other partners in DigiCare4You focus on the project implementation, clinical effectiveness and scalability, our team brings a health economic perspective to answer a crucial question: is DigiCare4You a smart investment for national healthcare systems?
Specifically, my role involves estimating the real-world implementation costs of DigiCare4You across the four implementation countries, i.e., Albania, Bulgaria, Greece and Spain. Second, we have developed a model that predicts the long-term value for money and financial impact of the DigiCare4You intervention. This evidence helps policymakers make informed decisions about investing in type 2 diabetes (T2D) and hypertension (HTN) prevention.
- Why is cost-effectiveness analysis an important aspect of our project?
As healthcare budgets are limited, every euro spent needs to be spent wisely. Countries need evidence to decide whether new interventions like DigiCare4You are worth the investment.
Cost-effectiveness analysis is a tool for comparing both costs and health outcomes: how much does the intervention cost, and what health gains do you get for that investment? It is like asking whether you get good value when buying a car, you want to know both the price and what you will get for your money.
This is especially important given the increasing pressure on healthcare budgets and the growing burden of T2D and HTN. By demonstrating that DigiCare4You is both effective and cost-effective, we can help policy makers make an informed decision as to whether to implement or scale up the intervention. The ultimate goal of health economic evaluations is to ensure healthcare budgets are invested in interventions that deliver the biggest health improvements for every euro spent.
- Could you tell us more about what your work has entailed so far?
We have been tracking all costs involved in rolling out the DigiCare4You intervention across Albania, Bulgaria, Greece and Spain. This includes collecting the costs associated with staff time, digital health tools like the smartphone application, laboratory tests and other resources. This data has been used to estimate what it actually costs to deliver the intervention in real-world settings during both the screening phase and the first year of the intervention in each country.
However, since clinical trials are limited in time, we wanted to look beyond the trial period to understand its long-term value. That is why we have developed a health economic model. Think of it like the models used during COVID-19 that predicted how interventions like mask-wearing would affect future infections and hospitalisations. Our model works similarly, examining how investing in DigiCare4You today will impact healthcare costs and people’s health outcomes over many years in the future.
This approach of modelling long-term impacts allows us to determine whether the short-term results observed during the trial will translate into sustained value for money. Essentially, we aim to answer the question: if we invest in DigiCare4You today, what will the long-term return be on that investment in terms of both health outcomes and costs?
- What, if any, challenges have you encountered?
We faced several challenges that highlight the complexity of conducting health economic evaluations across multiple countries with different healthcare systems.
The primary challenge has been finding reliable, country-specific data for our health economic model. Think of our model as a sophisticated calculator that predicts future costs and health benefits. It needs accurate input data to produce reliable results. That includes data on how quickly people with intermediate hyperglycaemia (often termed prediabetes) develop T2D, the healthcare costs of treating diabetes and its complications in each country, and the quality of life of people living with diabetes and complications, etc.
Another challenge has been streamlining the cost collection and estimation across the four countries. To address this, we developed standardised cost collection templates that all countries use, but we still need to check and validate the input data to ensure accuracy and consistency, which is essential for getting reliable cost estimates.
To address these challenges, we are continuously searching for better data sources, working with experts and health economists to validate our assumptions, and refining our data collection based on lessons learned. This ongoing and continuous optimisation process is essential for ensuring our cost-effectiveness estimates are as robust and reliable as possible to inform policymakers.
- What preliminary findings have emerged from your analysis?
Our initial analysis based on the first year of the intervention data reveals promising results supporting the value of investing in early prevention strategies. It suggests that DigiCare4You is cost-effective when targeting adults with intermediate hyperglycaemia.
Using the developed health economic model to estimate the cost-effectiveness of DigiCare4You after the first intervention year, we found that the intervention already looked like a smart investment in Albania, Bulgaria and Greece. The results for Spain were more mixed and less straightforward to interpret, requiring deeper analysis. However, when we focused our analysis specifically on the subgroup of people with intermediate hyperglycaemia, the intervention appears to be cost-effective across all four implementation countries.
It is important to note that these are early preliminary results based on only one year of intervention data. We need the complete results from the full two-year DigiCare4You intervention to confirm the findings and provide definitive recommendations.
- What are the next steps for your work in this project?
The next steps involve refining and optimising our health economic model to ensure it provides the most accurate predictions as possible. This involves continuously updating our model with the latest available data.
The most important next step is analysing the complete two-year DigiCare4You intervention results. This analysis will allow us to estimate the overall long-term value for money of the intervention which will guide our final recommendations in each implementation country. This evidence will be crucial for informing policymakers’ decisions about whether to invest in, and scale up, the DigiCare4You intervention within their national healthcare systems.
The ultimate goal is to provide policymakers and other decision-makers with clear, reliable evidence about whether DigiCare4You is a smart investment for the prevention of type 2 diabetes and hypertension.