Cost-Effectiveness of a Real-Time Continuous Glucose Monitoring System Versus Self-Monitoring of Blood Glucose in People with Type 2 Diabetes on Insulin Therapy in the UK

• Published in: Diabetes therapy Vol. 13; no. 11-12; pp. 1875 - 1890
• Main Authors: Isitt, John J., Roze, Stéphane, Sharland, Helen, Cogswell, Greg, Alshannaq, Hamza, Norman, Gregory J., Lynch, Peter M.
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01-12-2022; Springer; Springer Nature B.V
• Subjects: Blood; Blood sugar monitoring; Cardiology; Care and treatment; Clinical outcomes; Cohort analysis; Cost analysis; Diabetes; Diabetes therapy; Dosage and administration; Endocrinology; Glucose; Glucose monitoring; Insulin; Internal Medicine; Life expectancy; Management; Medicine; Medicine & Public Health; Methods; Original Research; Quality of life; Sensitivity analysis; Type 2 diabetes; United States; United Kingdom > UK; Type 2 diabetes; Real-time continuous glucose monitoring; Health economics; Cost effectiveness; UK; Insulin-treated T2D
• ISSN: 1869-6953; 1869-6961
• DOI: 10.1007/s13300-022-01324-x

Introduction
Real-time continuous glucose monitoring (rt-CGM) involves the measurement and display of glucose concentrations, potentially improving glucose control among insulin-treated patients with type 2 diabetes (T2D). The present analysis aimed to conduct a cost-effectiveness analysis of rt-CGM versus self-monitoring of blood glucose (SMBG) based on a USA retrospective cohort study in insulin-treated people with T2D adapted to the UK.
Methods
Long-term costs and clinical outcomes were estimated using the CORE Diabetes Model, with clinical input data sourced from a retrospective cohort study. Patients were assumed to have a baseline glycated hemoglobin (HbA1c) of 8.3%. Patients using rt-CGM were assumed to have a 0.56% reduction in HbA1c based on the mean difference between groups after 12 months of follow-up. Reduced fingerstick testing when using rt-CGM was associated with a quality of life (QoL) benefit. The analysis was performed over a lifetime time horizon from a National Health Service (NHS) perspective, including only direct costs from published data. Future costs and clinical outcomes were discounted at 3.5% per annum. Extensive sensitivity analyses were performed.
Results
Projections showed that rt-CGM was associated with increased quality-adjusted life expectancy of 0.731 quality-adjusted life years (QALYs) and increased mean total lifetime costs of Great British pounds (GBP) 2694, and an incremental cost-effectiveness ratio of GBP 3684 per QALY compared with SMBG. Key drivers of outcomes included HbA1c reduction and reduced fingerstick testing QoL benefit.
Conclusions
Over patient lifetimes, rt-CGM was associated with improved clinical outcomes and is highly likely to be cost effective versus SMBG in people with T2D on insulin therapy in the UK.