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Int J Med Inform. 2018 Jul;115:120-127. doi: 10.1016/j.ijmedinf.2018.04.012. Epub 2018 Apr 30.

Self-monitoring induced savings on type 2 diabetes patients' travel and healthcare costs.

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Department of Geographical and Historical Studies, University of Eastern Finland, P.O. Box 111, 80101 Joensuu, Finland. Electronic address:
Department of Geographical and Historical Studies, University of Eastern Finland, P.O. Box 111, 80101 Joensuu, Finland.
Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland; Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland.



Type 2 diabetes (T2DM) is a major health concern in most regions. In addition to direct healthcare costs, diabetes causes many indirect costs that are often ignored in economic analyses. Patients' travel and time costs associated with the follow-up of T2DM patients have not been previously calculated systematically over an entire healthcare district. The aim of the study was to develop a georeferenced cost model that could be used to measure healthcare accessibility and patient travel and time costs in a sparsely populated healthcare district in Finland. Additionally, the model was used to test whether savings in the total costs of follow-up of T2DM patients are achieved by increasing self-monitoring and implementing electronic feedback practices between healthcare staff and patients.


Patient data for this study was obtained from the regional electronic patient database Mediatri. A georeferenced cost model of linear equations was developed with ESRI ArcGIS 10.3 software and ModelBuilder tool. The Model utilizes OD Cost Matrix method of network analysis to calculate optimal routes for primary-care follow-up visits.


In the study region of North Karelia, the average annual total costs of T2DM follow-up screening of HbA1c (9070 patients) conforming to the national clinical guidelines are 280 EUR/297 USD per patient. Combined travel and time costs are 21 percent of the total costs. Implementing self-monitoring for a half of the follow-up still within the guidelines, the average annual total costs of HbA1c screening could be reduced by 57 percent from 280 EUR/297 USD to 121 EUR/129 USD per patient.


Travel costs related to HbA1c screening of T2DM patients constitute a substantial cost item, the consideration of which in healthcare planning would enable the societal cost-efficiency of T2DM care to be improved. Even more savings in both travel costs and healthcare costs of T2DM can be achieved by utilizing more self-monitoring and electronic feedback practices. Additionally, the cost model composed in the study can be developed and expanded further to address other healthcare processes and patient groups.


Electronic patient database; Georeferenced cost model; HbA1c screening; Healthcare accessibility; Network analysis; Self-monitoring

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