Cost analysis of the flash monitoring system (FreeStyle Libre 2) in adults with type 1 diabetes mellitus

Abstract

IntroductionCompare cost of the interstitial liquid glucose flash monitoring (FM) system (FreeStyle Libre 2) versus self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes mellitus (T1DM) in Spain.Research design and methodsA model was developed to estimate, with the perspective of the Spanish health system, the annual costs associated with glucose monitoring and hypoglycemic events management in T1DM population, with multiple insulin daily doses (MDI). According to published evidence, rate of severe hypoglycemia (SHE) of 4.90 episodes per patient-year was applied. Reduction of SHE (58.6%) was modeled associated with FM use. Published rates of hospital care (20.2%) and subsequent admission (16%) were assumed for SHE. The daily consumption of strips and lancets was 9 in patients with SMBG (before and after 4 daily intakes and at bedtime) and 0.5 for FM users (according to IMPACT trial findings). Annual consumption of 26 FM sensors was considered (1 every 14 days). Unit costs (in € of 2019, excluding VAT) were obtained from literature and national databases. Sensitivity analyses (SA) were carried out to evaluate the model robustness.ResultsThe total annual cost/patient was €4437 for SMBG and €2526 for FM. The use of FM would be associated with an annual savings in the costs of monitoring and managing hypoglycemic events of €1911 per patient-year. In a hypothetical cohort of 1000 patients with T1DM MDI, FM could avoid in 1 year 4900 SHE, 93 hospitalizations for SHE. In addition, the use of FM would generate total savings of up to €1 910 000 per year. In the SA with alternative hypoglycemia events rates and use of strips and lancets, and including non-SHE episodes, savings from €370 000 to €1 760 000 were observed with FM.ConclusionsThe use of the FM system to monitor glucose in adults with T1DM treated with MDI, would reduce hypoglycemic events and would result in cost savings for the health system.

Cost Analysis of FreeStyle Libre® 2 System in Type 2 Diabetes Mellitus Population

“…Previous analysis in Spain showed annual cost savings of nearly €2 million (euros year 2019) per 1000 adults patients associated with the use of the FreeStyle Libre 2 system in T1DM populations treated with multiple daily doses of insulin [ 28 ].…”

“…In this study a cost analysis was conducted of the FreeStyle Libre 2 system compared to SMBG in adults with T2DM treated with basal-bolus insulin in Spain, which complements a previous analysis published for T1DM [ 28 ].…”

“…A cost analysis model previously developed for T1DM [ 28 ] was used to estimate the economic impact associated with glucose monitoring and the management of hypoglycaemic events in a hypothetical cohort of 1000 adult (> 18 years) patients with T2DM treated with basal-bolus insulin regimen, using the FreeStyle Libre 2 system as compared to standard practice based on SMBG only. The FreeStyle Libre 2 system has been considered in the analysis, as this version of the FreeStyle Libre system will be available in Spain as of early 2020.…”

“…The unit costs (in € year 2020 and excluding VAT) were obtained from the reviewed literature (€0.28 /strip [ 28 ], €0.09/lancet [ 28 ], €3.09/daily FreeStyle Libre 2 sensor [ 28 ], €3804.17/severe hypoglycaemic episode with hospital admission [ 36 ], €1793.74/severe hypoglycaemic episode with emergency hospital care but no admission [ 33 ], €388.83/severe hypoglycaemic episode without hospital care [ 37 ]).…”

American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus

“…Another modeling study evaluated the cost-effectiveness of isCGM versus SMBG in a hypothetical cohort of 1000 persons with T1D living in Spain. 68 The total annual cost/patient was $5405 for SMBG versus $3077 for isCGM (converted from Euros to USD). The investigators determined that the use of isCGM would be associated with an annual savings of $2328 per patient-year due to reductions in the costs of monitoring and managing hypoglycemic events.…”