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New ways to cut healthcare costs: Sodium targets and glucose monitors

While the findings of two new research studies are unrelated, each is noteworthy in the opportunity presented to help bend the healthcare cost curve.

Jeff Lagasse, Associate Editor

Two different studies came to light this week showing avenues of sizable cost-savings when it comes the FDA's new sodium levels and the use of continuous glucose monitoring technologies. 

Commercial adherence to the Food and Drug Administration's 2016 sodium reformulation targets for processed foods will reduce cardiovascular disease, effectively saving both lives and money, according to a study published this week in PLOS Medicine.

The study estimates that, over a 20-year period, even modest adherence to the FDA targets will gain 1.1 million discounted quality-adjusted life years, or QALYs, from reduced cases of cardiovascular disease and other causes, and save $19 billion in societal and healthcare costs.

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Sodium consumption is a leading, modifiable risk factor for high blood pressure and CVD in the U.S. and worldwide. To reduce sodium consumption, the FDA in 2016 proposed two-year and 10-year voluntary sodium reformulation targets for commercially processed, packaged and prepared foods. But the potential health and economic effects of these proposed targets hadn't truly been estimated.

The researchers project that the optimal scenario -- 100 percent compliance with the 10-year FDA targets -- could gain approximately two million QALYs and produce discounted cost savings of approximately $40 billion. 

In contrast, the modest scenario (50 percent compliance with the 10-year FDA targets) and the pessimistic scenario (100 percent compliance with the 2-year targets but no further progress) could yield health and economic gains half and a quarter as large, respectively. The model predicts that all three scenarios have a greater than 80 percent probability of being cost-effective by 2021, and cost-saving by 2031.

The authors said that failure to comply fully with the targets could result in a significant number of preventable CVD-related illnesses and deaths, as well as costs to hospitals and the wider economy.

Another new study, conducted by researchers from the University of Chicago Medicine, found that use of a continuous glucose monitor is cost-effective for adult patients with Type 1 diabetes when compared to daily use of test strips. The results are well within the thresholds normally used by insurance plans to cover medical devices

A continuous glucose monitor uses a tiny sensor inserted under the skin to test blood sugar levels every few minutes throughout the day, and wirelessly sends those data to a monitor. The first generation of CGMs transmitted data to a stand-alone electronic device that looks like a pager, but newer models can work with apps on smartphones and smartwatches. This provides near-real time information, and allows diabetics to adjust their physical activity, food intake or insulin levels quickly, preventing severe high or low blood sugar episodes.

At the end of the six-month trial, the total healthcare costs of using a CGM was $11,032, compared to $7,236 for manual testing. The cost differences were mostly due to the upfront cost of the CGM device, about $2,500. But the CGM group saw reductions in their hemoglobin A1C levels, a common measure of blood sugar control, and experienced fewer non-severe low blood sugar events.

The analysis calculated an incremental cost-effectiveness ratio, which shows the difference in costs for a treatment -- in this case the CGM vs. daily test strips -- over the health benefit it adds, or the quality of life years. The cost-effectiveness ratio for the CGM was about $100,000 per quality-adjusted life year or QALY, for the overall population. 

This is well below the threshold insurance plans and government agencies such as Medicare normally use to decide whether or not to cover a new treatment or medical device. The ratio was calculated based on the recommendation to use a CGM sensor for seven days, but if that use was extended to 10 days, as many people do, that ratio was reduced to about $33,000 per QALY.

Twitter: @JELagasse
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