Cost-effectiveness of continuous glucose monitoring and intensive insulin therapy for type 1 diabetes

Abstract

BackgroundOur objective was to determine the cost-effectiveness of Continuous Glucose Monitoring (CGM) technology with intensive insulin therapy compared to self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes in the United States.MethodsA Markov cohort analysis was used to model the long-term disease progression of 12 different diabetes disease states, using a cycle length of 1 year with a 33-year time horizon. The analysis uses a societal perspective to model a population with a 20-year history of diabetes with mean age of 40. Costs are expressed in $US 2007, effectiveness in quality-adjusted life years (QALYs). Parameter estimates and their ranges were derived from the literature. Utility estimates were drawn from the EQ-5D catalogue. Probabilities were derived from the Diabetes Control and Complications Trial (DCCT), the United Kingdom Prospective Diabetes Study (UKPDS), and the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Costs and QALYs were discounted at 3% per year. Univariate and Multivariate probabilistic sensitivity analyses were conducted using 10,000 Monte Carlo simulations.ResultsCompared to SMBG, use of CGM with intensive insulin treatment resulted in an expected improvement in effectiveness of 0.52 QALYs, and an expected increase in cost of $23,552, resulting in an ICER of approximately $45,033/QALY. For a willingness-to-pay (WTP) of $100,000/QALY, CGM with intensive insulin therapy was cost-effective in 70% of the Monte Carlo simulations.ConclusionsCGM with intensive insulin therapy appears to be cost-effective relative to SMBG and other societal health interventions.

The Benefits, Limitations, and Cost-Effectiveness of Advanced Technologies in the Management of Patients With Diabetes Mellitus

“…McQueen and colleagues found a somewhat lower ICER of $45 033/QALY but this also did not include cost-reduction from severe hypoglycemia avoidance. 68 Ly and colleagues estimated the incremental cost of RT-CGM as part of a LGTS system and did include the costs associated with severe hypoglycemic events such as hospital admission, accidents, emergency visits, and ambulance calls. They found that the cost per QALY was AUS$40 803 in patients ≥12 years.…”

Reimbursement for Continuous Glucose Monitoring: A European View

“…1,2 In these analyses, the authors use health economic models and assumptions to investigate whether the use of CGM systems optimizes glycemic control to such an extent that the reduction in the cost of treating diabetes-related complications outweighs the cost of using the CGM systems or even makes their use cost saving. Usually, quality-adjusted life years gained and the corresponding incremental cost-effectiveness ratio are calculated to provide evidence for cost-effectiveness.…”

Real-time continuous glucose monitoring (CGM) integrated into the treatment of type 1 diabetes: Consensus of experts from SFD, EVADIAC and SFE

“…A good cost-utility ratio for CGM is particularly important where reimbursement is to be obtained for the device. Two studies have evaluated this ratio [53,54].…”