Cost-Effectiveness of a Continuous Glucose Monitoring Mobile App for Patients With Type 2 Diabetes Mellitus: Analysis Simulation

Abstract

Background Apps for real-time continuous glucose monitoring (CGM) on smartphones and other devices linked to CGM systems have recently been developed, and such CGM apps are also coming into use in Japan. In comparison with conventional retrospective CGM, the use of CGM apps improves patients’ own blood glucose control, which is expected to help slow the progression of type 2 diabetes mellitus (DM) and prevent complications, but the effect of their introduction on medical costs remains unknown. Objective Our objective in this study was to perform an economic appraisal of CGM apps from the viewpoint of assessing public medical costs associated with type 2 DM, using the probability of developing type 2 DM–associated complications, and data on medical costs and utility value to carry out a medical cost simulation using a Markov model in order to ascertain the cost-effectiveness of the apps. Methods We developed a Markov model with the transition states of insulin therapy, nephrosis, dialysis, and cardiovascular disease, all of which have a major effect on medical costs, to identify changes in medical costs and utility values resulting from the introduction of a CGM app and calculated the incremental cost-effectiveness ratio (ICER). Results The ICER for CGM app use was US $33,039/quality-adjusted life year (QALY). Conclusions Sensitivity analyses showed that, with the exception of conditions where the transition probability of insulin therapy, utility value, or increased medical costs increases, the ICER for the introduction of CGM apps was below the threshold of US $43,478/QALY used by the Central Social Insurance Medical Council. Our results provide basic data on the cost-effectiveness of introducing CGM apps, which are currently starting to come into use.

Type 2 Diabetes and the Use of Real-Time Continuous Glucose Monitoring

“…Practitioners involved in providing CGM to patients will seek more guidance than is presently available to make educated choices about which patients will benefit most from this technology, and how to optimize its use in those individuals. Although an early estimate of cost-effectiveness has been favorable at $33,039 per quality-adjusted life year, insurers are likely to seek more outcomes data and reduced cost to apply to the widest spectrum of patients with T2D 62 . However, cost effectiveness may be demonstrated for a subset of the T2D population, particularly if they have significant hypoglycemia or high glycemic variability.…”

“…Although an early estimate of cost-effectiveness has been favorable at $33,039 per quality-adjusted life year, insurers are likely to seek more outcomes data and reduced cost to apply to the widest spectrum of patients with T2D. 62 However, cost-effectiveness may be demonstrated for a subset of the T2D population, particularly if they have significant hypoglycemia or high glycemic variability. So far, no study in T2D has selected patients with documented hypoglycemic unawareness or a history of severe hypoglycemic episodes.…”

Mobile health monitoring based studies for diabetes mellitus: a review

“… Continuous glucose monitoring systems should be investigated and evaluated further [93].  Cost-effectiveness for diabetes healthcare industry should be extensively evaluated [94]  Diversity of multiple devices and protocols represents a serious challenge to be addressed [98]  User acceptability and usability, e.g., lack of patient experience on using advanced technologies is one of the main challenges [99].  Advanced technologies such as IoT, big data analytics, neuro-fuzzy, and advanced signal and image processing should be used to develop mHelath based applications for diabetes [100]- [106].…”

Cost-Effectiveness Evaluation of a Remote Monitoring Programme Including Lifestyle Education Software in Type 2 Diabetes: Results of the Educ@dom Study

“…This paper notably assessed the cost-effectiveness of a TMG device in the German, Italian and Greek health care contexts. Finally, a 2020 study assessed, by simulation, the cost-utility of TMG for patients with T2D in Japan over 20 years [34]. Using a Markov model, this paper aimed to assess the effect of continuous glucose monitoring (CGM) on T2D management, taking into account the probability of transitioning to a related T2D complication state.…”

“…Telemonitoring or tele-education strategies are still struggling to prove their cost-effectiveness in the management of diabetes, largely due to a scarcity of data and a general focus on telephone-and internet-based interventions [11][12][13]. Health economic studies of innovative tools that aim to optimize diabetes management are crucial to enhancing their acceptance by health authorities in the long term.…”