Economic Value of Improved Accuracy for Self-Monitoring of Blood Glucose Devices for Type 1 Diabetes in Canada

Abstract

Glucose monitoring, frequent hemoglobin A1c testing (HbA1c), and intensive insulin treatment are of critical importance for managing type 1 diabetes. 1 Patient self-monitoring of blood glucose (SMBG) requires daily tracking of glucose concentrations, and should be carried out multiple times per day for patients using intensive insulin therapy. Frequent SMBG improves glycemic control and assists in avoiding acute complications such as hypoglycemia. 1,2 However, not all SMBG devices have the same accuracy which can lead to inaccurate insulin dosing. Given that clinical trials assessing the relationship between SMBG accuracy and glycemic control are difficult to design and conduct, Breton and Kovatchev employed a realistic computer simulation to provide evidence on the relationship between SMBG accuracy and glycemic control. 3 Specifically, the authors found that as SMBG errors increase, HbA1c increases or separately, the risk of hypoglycemic episodes increase. Moreover, past evidence has suggested an association between improved glycemic control and cost savings as well as improved quality of life. 4,5

Economic Value of Improved Accuracy for Self-Monitoring of Blood Glucose Devices for Type 1 and Type 2 Diabetes in England

“…Our modeling findings are similar to other modeling results associating SMBG accuracy standards with clinical and economic outcomes. 10,45 Our previous modeling findings found improved accuracy of SMBG devices in type 1 diabetes resulted in efficient and affordable findings from a Canadian payer perspective. Our current analysis differs with the addition of insulin-treated type 2 diabetes patients and the application to an English NHS perspective which has a different willingness-to-pay threshold than Canada.…”

“…This approach is consistent with the previous version of this model used in the Canadian setting which adopted equivalent utility values for the two health states. 10 For type 2 diabetes, the economic model informing the NICE Guideline 30 was based on the same UKPDS model and used the same health states as the current model.…”

“…9 Previous evidence suggested investing in SMBG devices with higher strip prices and less error may offset downstream costs associated with complications. 10 Previous analyses associating changes in SMBG error to economic outcomes have been applied to the Canadian and German setting in type 1 diabetes patients only; however, evidence is lacking in England and among insulin-treated type 2 diabetes patients. 10,11 The objective of this study was to expand these previous analyses by estimating the costeffectiveness of blood glucose monitoring devices with varying SMBG error (ie, SMBG devices meeting and exceeding standards allowed by ISO 15197:2013/EN ISO 15197:2015) and strip price among type 1 and insulin-treated type 2 diabetes (hereto referred as type 2 diabetes) patients from the English NHS perspective.…”

“…9 Previous evidence suggested investing in SMBG devices with higher strip prices and less error may offset downstream costs associated with complications. 10…”

Metabolic Effects Associated with ICS in Patients with COPD and Comorbid Type 2 Diabetes: A Historical Matched Cohort Study

“…The average follow-up time was 1.4 years: if the study had measured HbA 1c change over one year, the observed change would be approximately 0.11% (0.16/1.4). It is possible that such small changes accumulating over a longer time period could be clinically important, impacting on quality of life or the risk of long-term diabetes complications, as discussed by McQueen et al[ 31 ]. This issue calls for further research to investigate the long-term effects.…”