Advertisement

Health and Technology

, Volume 5, Issue 2, pp 127–133 | Cite as

Costs of development and maintenance of an internet program for teens with type 1 diabetes

  • Margaret Grey
  • Lauren LibertiEmail author
  • Robin Whittemore
Original Paper

Abstract

Many adolescents with type 1 diabetes (T1D) have difficulty completing self-management tasks within the context of their social environments. Group-based approaches to psycho-educational support have been shown to prevent declines in glucose control, but are challenging to implement due to youths’ many activities and costs. A novel solution is providing psycho-educational support via the internet. The purpose of this study is to describe the cost of developing and maintaining two internet psycho-educational programs, both of which have been shown to improve health outcomes in adolescents with T1D. We calculated actual costs of personnel and programming in the development of TEENCOPE™ and Managing Diabetes, two highly interactive programs that were evaluated in a multi-site clinical trial (n = 320). Cost calculations were set at U.S. dollars and converted to value for 2013 as expenses were incurred over 6 years. Development costs over 1.5 years totaled $324,609, with the majority of costs being for personnel to develop and write content in a creative and engaging format, to get feedback from teens on content and a prototype, and IT programming. Maintenance of the program, including IT support, a part-time moderator to assure safety of the discussion board (0.5–1 hour/week), and yearly update of content was $43,845/year, or $137.00 per youth over 4.5 years. Overall, program and site development were relatively expensive, but the program reach was high, including non-white youth from 4 geographically distinct regions. Once developed, maintenance was minimal. With greater dissemination, cost-per-youth would decrease markedly, beginning to offset the high development expense.

Keywords

Internet intervention eHealth Type 1 diabetes Cost Economics 

Notes

Acknowledgments

This study was funded by the National Institutes of Nursing Research (NINR)/National Institutes of Health (NIH) grant #2R01NR004009 to Margaret Grey and Robin Whittemore, PIs. Development of the Internet programs was supported by intramural funds provided to Margaret Grey.

Ethical statement

Neither the entire paper nor any of its content has been submitted, published, or accepted by another journal. The paper will not be submitted elsewhere if accepted for publication in Health and Technology. No data have been fabricated, manipulated or plagiarized. All co-authors have contributed sufficiently to this work. They and responsible authorities at Yale University consent to the submission of this manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Liese AD, D’Agostino Jr RB, Hamman RF, Kilgo PD, Lawrence JM, Liu LL, et al. Search for diabetes in youth study group. The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for diabetes in youth study. Pediatrics. 2006;118(4):1510–8. doi: 10.1542/peds.2006-0690.CrossRefGoogle Scholar
  2. 2.
    Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group. J Pediatr. 1994;125(2):177–88.Google Scholar
  3. 3.
    Davidson M, Penney ED, Muller B, Grey M. Stressors and self-care challenges faced by adolescents living with type 1 diabetes. Appl Nurs Res: ANR. 2004;17(2):72–80.CrossRefGoogle Scholar
  4. 4.
    Jaser SS, Faulkner MS, Whittemore R, Jeon S, Murphy K, Delamater A, et al. Coping, self-management, and adaptation in adolescents with type 1 diabetes. Ann Behav Med: PublSoc Behav Med. 2012;43(3):311–9. doi: 10.1007/s12160-012-9343-z.CrossRefGoogle Scholar
  5. 5.
    Chiang JL, Kirkman MS, Laffel LM, Peters AL. Type 1 diabetes sourcebook a. Type 1 diabetes through the life span: a position statement of the american diabetes association. Diabetes Care. 2014;37(7):2034–54. doi: 10.2337/dc14-1140.CrossRefGoogle Scholar
  6. 6.
    Grey M, Whittemore R, Jaser S, Ambrosino J, Lindemann E, Liberti L, et al. Effects of coping skills training in school-age children with type 1 diabetes. Res Nurs Health. 2009;32(4):405–18. doi: 10.1002/nur.20336.CrossRefGoogle Scholar
  7. 7.
    Hampl S, Demeule M, Eneli I, Frank M, Hawkins MJ, Kirk S, et al. Parent perspectives on attrition from tertiary care pediatric weight management programs. Clin Pediatr. 2013;52(6):513–9. doi: 10.1177/0009922813482515.CrossRefGoogle Scholar
  8. 8.
    Sallinen Gaffka BJ, Frank M, Hampl S, Santos M, Rhodes ET. Parents and pediatric weight management attrition: experiences and recommendations. Childhood Obes. 2013;9(5):409–17. doi: 10.1089/chi.2013.0069.Google Scholar
  9. 9.
    Grey M, Boland EA, Davidson M, Yu C, Tamborlane WV. Coping skills training for youths with diabetes on intensive therapy. Appl Nurs Res: ANR. 1999;12(1):3–12.CrossRefGoogle Scholar
  10. 10.
    Grey M, Whittemore R, Liberti L, Delamater A, Murphy K, Faulkner MS. A comparison of two internet programs for adolescents with type 1 diabetes: design and methods. Contemp Clin Trials. 2012;33(4):769–76. doi: 10.1016/j.cct.2012.03.012.CrossRefGoogle Scholar
  11. 11.
    Griffiths F, Lindenmeyer A, Powell J, Lowe P, Thorogood M. Why are health care interventions delivered over the internet? A systematic review of the published literature. J Med Internet Res. 2006;8(2):e10. doi: 10.2196/jmir.8.2.e10.CrossRefGoogle Scholar
  12. 12.
    Tate DF, Finkelstein EA, Khavjou O, Gustafson A. Cost effectiveness of internet interventions: review and recommendations. Ann Behav Med: Publ Soc Behav Med. 2009;38(1):40–5. doi: 10.1007/s12160-009-9131-6.CrossRefGoogle Scholar
  13. 13.
    Madden M, Lenhart A, Duggan M, Cortesi S, Gasser U. Teens and Technology 2013. Pew Research Internet Project 2013Google Scholar
  14. 14.
    Hedman E, Ljotsson B, Lindefors N. Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost-effectiveness. Expert Rev Pharmacoecon Outcomes Res. 2012;12(6):745–64. doi: 10.1586/erp.12.67.CrossRefGoogle Scholar
  15. 15.
    van der Zanden R, Kramer J, Gerrits R, Cuijpers P. Effectiveness of an online group course for depression in adolescents and young adults: a randomized trial. J Med Internet Res. 2012;14(3):e86. doi: 10.2196/jmir.2033.CrossRefGoogle Scholar
  16. 16.
    Richardson T, Stallard P, Velleman S. Computerised cognitive behavioural therapy for the prevention and treatment of depression and anxiety in children and adolescents: a systematic review. Clin Child Fam Psychol Rev. 2010;13(3):275–90. doi: 10.1007/s10567-010-0069-9.CrossRefGoogle Scholar
  17. 17.
    Sjostrom M, Umefjord G, Lindholm L, Samuelsson E. Cost-effectiveness of an internet-based treatment program for stress urinary incontinence. Neurourol Urodyn. 2013. doi: 10.1002/nau.22540.Google Scholar
  18. 18.
    Page TF, Horvath KJ, Danilenko GP, Williams M. A cost analysis of an internet-based medication adherence intervention for people living with HIV. J Acquir Immune Defic Syndr. 2012;60(1):1–4. doi: 10.1097/QAI.0b013e318250f011.CrossRefGoogle Scholar
  19. 19.
    Ritterband LM, Andersson G, Christensen HM, Carlbring P, Cuijpers P. Directions for the international society for research on internet interventions (ISRII). J Med Internet Res. 2006;8(3):e23. doi: 10.2196/jmir.8.3.e23.CrossRefGoogle Scholar
  20. 20.
    Murray E. Web-based interventions for behavior change and self-management: potential, pitfalls, and progress. Medicine 20. 2012;1(2):e3. doi: 10.2196/med20.1741.Google Scholar
  21. 21.
    Ritterband LM, Thorndike FP, Lord HR, Borowitz S, Walker LS, Ingersoll KS, et al. An RCT of an internet intervention for pediatric encopresis with One year follow-Up. Clin Pract Pediatr Psychol. 2013;1(1):68–80. doi: 10.1037/cpp0000007.CrossRefGoogle Scholar
  22. 22.
    Kurowski BG, Wade SL, Kirkwood MW, Brown TM, Stancin T, Taylor HG. Long-term benefits of an early online problem-solving intervention for executive dysfunction after traumatic brain injury in children: a randomized clinical trial. JAMA Pediatr. 2014;168(6):523–31. doi: 10.1001/jamapediatrics.2013.5070.CrossRefGoogle Scholar
  23. 23.
    Grey M, Whittemore R, Jeon S, Murphy K, Faulkner MS, Delamater A, et al. Internet psycho-education programs improve outcomes in youth with type 1 diabetes. Diabetes Care. 2013;36(9):2475–82. doi: 10.2337/dc12-2199.CrossRefGoogle Scholar
  24. 24.
    Mulvaney SA, Rothman RL, Wallston KA, Lybarger C, Dietrich MS. An internet-based program to improve self-management in adolescents with type 1 diabetes. Diabetes Care. 2010;33(3):602–4. doi: 10.2337/dc09-1881.CrossRefGoogle Scholar
  25. 25.
    Jones M, Taylor Lynch K, Kass AE, Burrows A, Williams J, Wilfley DE, et al. Healthy weight regulation and eating disorder prevention in high school students: a universal and targeted Web-based intervention. J Med Internet Res. 2014;16(2):e57. doi: 10.2196/jmir.2995.CrossRefGoogle Scholar
  26. 26.
    Newton NC, Andrews G, Champion KE, Teesson M. Universal Internet-based prevention for alcohol and cannabis use reduces truancy, psychological distress and moral disengagement: a cluster randomised controlled trial. Prev Med. 2014;65:109–15. doi: 10.1016/j.ypmed.2014.05.003.CrossRefGoogle Scholar
  27. 27.
    Park E, Drake E. Systematic review: internet-based program for youth smoking prevention and cessation. J Nurs Scholarsh: Off Publ Sigma Theta Tau Int Honor Soc Nurs / Sigma Theta Tau. 2014. doi: 10.1111/jnu.12104.Google Scholar
  28. 28.
    Smit ES, Evers SM, de Vries H, Hoving C. Cost-effectiveness and cost-utility of Internet-based computer tailoring for smoking cessation. J Med Internet Res. 2013;15(3):e57. doi: 10.2196/jmir.2059.CrossRefGoogle Scholar
  29. 29.
    Krukowski RA, Tilford JM, Harvey-Berino J, West DS. Comparing behavioral weight loss modalities: incremental cost-effectiveness of an internet-based versus an in-person condition. Obesity. 2011;19(8):1629–35. doi: 10.1038/oby.2010.341.CrossRefGoogle Scholar
  30. 30.
    Schulz DN, Smit ES, Stanczyk NE, Kremers SP, de Vries H, Evers SM. Economic evaluation of a web-based tailored lifestyle intervention for adults: findings regarding cost-effectiveness and cost-utility from a randomized controlled trial. J Med Internet Res. 2014;16(3):e91. doi: 10.2196/jmir.3159.CrossRefGoogle Scholar
  31. 31.
    Blankers M, Nabitz U, Smit F, Koeter MW, Schippers GM. Economic evaluation of internet-based interventions for harmful alcohol use alongside a pragmatic randomized controlled trial. J Med Internet Res. 2012;14(5):e134. doi: 10.2196/jmir.2052.CrossRefGoogle Scholar
  32. 32.
    Lewis BA, Williams DM, Neighbors CJ, Jakicic JM, Marcus BH. Cost analysis of internet vs. Print interventions for physical activity promotion. Psychol Sports Exerc. 2010;11(3):246–9. doi: 10.1016/j.psychsport.2009.10.002.CrossRefGoogle Scholar
  33. 33.
    Meenan RT, Stevens VJ, Funk K, Bauck A, Jerome GJ, Lien LF, et al. Development and implementation cost analysis of telephone- and Internet-based interventions for the maintenance of weight loss. Int J Technol Assess Health Care. 2009;25(3):400–10. doi: 10.1017/S0266462309990018.CrossRefGoogle Scholar
  34. 34.
    Rasu RS, Hunter CM, Peterson AL, Maruska HM, Foreyt JP. Economic evaluation of an Internet-based weight management program. Am J Manage Care. 2010;16(4):e98–104.Google Scholar
  35. 35.
    Gage H, Hampson S, Skinner TC, Hart J, Storey L, Foxcroft D, et al. Educational and psychosocial programmes for adolescents with diabetes: approaches, outcomes and cost-effectiveness. Patient Educ Couns. 2004;53(3):333–46. doi: 10.1016/j.pec.2003.06.003.CrossRefGoogle Scholar
  36. 36.
    Levine BA, Turner JW, Robinson JD, Angelus P, Hu TM. Communication plays a critical role in web-based monitoring. J Diabetes Sci Technol. 2009;3(3):461–7.CrossRefGoogle Scholar
  37. 37.
    Newton KT, Ashley A. Pilot study of a web-based intervention for adolescents with type 1 diabetes. J Telemed Telecare. 2013;19(8):443–9. doi: 10.1177/1357633X13512069.CrossRefGoogle Scholar
  38. 38.
    Nordqvist C, Hanberger L, Timpka T, Nordfeldt S. Health professionals’ attitudes towards using a Web 2.0 portal for child and adolescent diabetes care: qualitative study. J Med Internet Res. 2009;11(2):e12. doi: 10.2196/jmir.1152.CrossRefGoogle Scholar
  39. 39.
    Boogerd EA, Noordam C, Verhaak CM. The Sugarsquare study: protocol of a multicenter randomized controlled trial concerning a web-based patient portal for parents of a child with type 1 diabetes. BMC Pediatr. 2014;14:24. doi: 10.1186/1471-2431-14-24.CrossRefGoogle Scholar
  40. 40.
    Ekberg J, Ericson L, Timpka T, Eriksson H, Nordfeldt S, Hanberger L, et al. Web 2.0 systems supporting childhood chronic disease management: design guidelines based on information behaviour and social learning theories. J Med Syst. 2010;34(2):107–17.CrossRefGoogle Scholar
  41. 41.
    Whittemore R, Grey M, Lindemann E, Ambrosino J, Jaser S. Development of an Internet coping skills training program for teenagers with type 1 diabetes. Comput Inform Nurs: CIN. 2010;28(2):103–11. doi: 10.1097/NCN.0b013e3181cd8199.CrossRefGoogle Scholar
  42. 42.
    Whittemore R, Jaser SS, Faulkner MS, Murphy K, Delamater A, Grey M, et al. Type 1 diabetes eHealth psychoeducation: youth recruitment, participation, and satisfaction. J Med Internet Res. 2013;15(1):e15. doi: 10.2196/jmir.2170.CrossRefGoogle Scholar
  43. 43.
    Lewis ML, Hobday JV, Hepburn KW. Internet-based program for dementia caregivers. Am J Alzheimers Dis Other Demen. 2010;25(8):674–9. doi: 10.1177/1533317510385812.CrossRefGoogle Scholar
  44. 44.
    JDRF. Statistics: JDRF and Diabetes. 2012.Google Scholar
  45. 45.
    Lee JM, Rhee K, O’Grady MJ, Basu A, Winn A, John P, et al. Health utilities for children and adults with type 1 diabetes. Med Care. 2011;49(10):924–31. doi: 10.1097/MLR.0b013e318216592c.CrossRefGoogle Scholar

Copyright information

© IUPESM and Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Margaret Grey
    • 1
  • Lauren Liberti
    • 1
    Email author
  • Robin Whittemore
    • 1
  1. 1.Yale University School of NursingOrangeUSA

Personalised recommendations