I can see how researchers are excited by DiRECT based on trial design where as physicians working with patients are excited by virta’s results.
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Actually, not so much. None of the clinicians I know has so far been impressed with Virta, particularly after seeing the ~$6,000 AUD per year price tag
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If finance is concern then you need to run the numbers. What is the cost savings of insulin reduction/elimination, other medications, and then estimate decrease in T2d complications based on lowering a1c, ldl-p, bp, crp, etc. etc Suspect $6000 is very cost effective.
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But we have no way of knowing if it's cost-effective. For that, we'd have to have an RCT comparing Virta to at least normal care (or ideally best-practice care), and create an incremental cost-effectiveness ratio. That's kind of the problem with running a flawed trial!
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Do you think virta’s cost saving estimates per patient are out of keeping with reality? It would be neat to see Virta type IT platforms serve as a delivery system of different well designed dietary interventions for RCT purposes. Lot of $$ would be needed to develop resources.
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I'm not saying they're out of keeping with reality, but I would say that they are, similarly to the study, misleading, because it's a case of comparing Virta to another effective treatment, not care as usual/nothing
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For example, we are currently applying for grant funding to run a trial similar to DiRECT, and our cost per patient/year including supplying all meal replacement and drugs comes out somewhere between 1/4 and 1/3 of the cost of Virta including study costs
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The current Virta economics are basically comparing Virta with their control - no treatment What would they look like if they were compared to another, cheaper, intensive lifestyle control program? There's one at the hospital I work at that's run at a fraction of the cost
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But all of this comes back to a really rigorous RCT! If we had such results, and cost data, we could know exactly how effective Virta is compared to the next best treatment Alas, we don't have this information, which is a big issue
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Has anyone looked at cost effectiveness as it related to CSIRO study? Seems that could give a satisfactory answer with regards to cost savings from med reductions in the low carb arm.
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I don't think they looked at costs from memory, they used a combination medication score. They also didn't use Virta, I believe their model was less intensive. Also, the cost-benefit of a 0.3 reduction in medication effect score might not be very high
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Also brings it back to one of the big problems with Virta - they didn't test ketogenic diets! They showed a benefit for $6,000/year subscription services, but do you think there'd still be the same benefit if the ctrl arm had been given a low-fat version of Virta?
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I’m sure it would cost a lot of $ generating the educational materials needed to mirror the LCHF approach but would be a brilliant way to do a RCT and collect large amounts of data.
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