InvesT1D: Promoting Adolescent Investment in Diabetes Care
- National Institutes of Health (NIH)
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Project Summary
Over 80% of adolescents with type 1 diabetes (T1D) struggle to achieve good glycemic control, placing them at risk for acute and chronic complications. Instilling good T1D management practices in adolescence can set a pattern into adulthood, improving long-term health while reducing future burden on patient and family quality of life, adolescent psychosocial development, and the health care system. Health psychology and economics research suggest that financial incentives can increase adolescent adherence to T1D self-management regimens.
We developed InvesT1D, a flexible, patient centered incentives intervention based on rigorous developmental research that included qualitative, ethical, and stated preference analyses. A pilot randomized controlled trial (RCT) demonstrated that InvesT1D was effective at improving adherence to self-management goals and time-in-range among continuous glucose monitor users. This larger, more comprehensive study will help to determine the most efficacious financial incentive structure and to evaluate InvesT1D’s impact on time-in-range, HbA1c, adverse events, long-term health, diabetes distress, family conflict, health care utilization, and adolescent and caregiver quality of life. We will use mixed methods to evaluate InvesT1D’s efficacy, long-term health benefits, cost-effectiveness, and implementation feasibility. Our innovative approach includes a Randomized Control Trial with a diverse sample of 12- to 18-year-old adolescents with type 1 diabetes, trial- and model-based economic evaluations (from the payer, health care, and societal perspectives), a policy analysis, the development of a decision support dashboard, and qualitative interviews with patient, health care payer, and health care delivery system stakeholders.
Aims
Adolescents (n = 96 total) using continuous glucose monitors will be randomized to one of four incentive intervention arms or to usual care. We will vary (a) the length of the financial incentives program (6 to 12 months) and (b) the value of incentives ($60 to $120 per month) to understand the impact of the incentive structure on time-in-range (primary outcome), HbA1c, adherence to self-management behaviors, diabetes distress, and health-related quality of life over a 12 to 18-month time horizon.
Use RCT outcomes data and the IQVIA CORE Diabetes Markov model to forecast the long-term impact of InvesT1D on the health and quality of life of patients with T1D. This validated simulation model can estimate the impact of InvesT1D on diabetes-related complications, health related quality of life, and health care utilization over a lifetime horizon.
We will quantify health care service utilization and costs associated with InvesT1D vs. usual care using a detailed, prospective economic analysis conducted from the payer, health care, and societal perspectives over a lifetime horizon. Long-term health and economic outcomes will be simulated using the IQVIA Core Diabetes Model. The primary outcome will be the incremental cost-effectiveness ratio ($/quality-adjusted life years (QALYs) gained).
(A) We will identify policy-related barriers to financial incentives implementation through a 50-state review of laws. (B) These data and data from Aims 1-3 will be used to create an interactive dashboard to allow public and private health plan and health care delivery system representatives (n = 20) to estimate the health and economic impact of InvesT1D within their populations. Stakeholders will use the dashboard and we will conduct qualitative interviews to assess facilitators and barriers to real-world, equitable implementation.