The Cost-Effectiveness of Real-Time Continuous Glucose Monitoring (RT-CGM) in Type 2 Diabetes

• Published in: Journal of diabetes science and technology Vol. 10; no. 4; pp. 898 - 904
• Main Authors: Fonda, Stephanie J., Graham, Claudia, Munakata, Julie, Powers, Julia M., Price, David, Vigersky, Robert A.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.07.2016
• Subjects: Adult; Aged; Blood Glucose - analysis; Blood Glucose Self-Monitoring - economics; Computer Simulation; Cost-Benefit Analysis; Diabetes Mellitus, Type 2 - blood; Female; Humans; Male; Middle Aged; Original; Quality-Adjusted Life Years; Randomized Controlled Trials as Topic; cost-effectiveness; behavior; continuous glucose monitoring; self-care; self-monitoring; health economics
• ISSN: 1932-2968; 1932-2968; 1932-3107
• DOI: 10.1177/1932296816628547

Background: This analysis models the cost-effectiveness of real-time continuous glucose monitoring (RT-CGM) using evidence from a randomized controlled trial (RCT) that demonstrated RT-CGM reduced A1C, for up to 9 months after using the technology, among patients with type 2 diabetes not on prandial insulin. RT-CGM was offered short-term and intermittently as a self-care tool to inform patients’ behavior. Method: The analyses projected lifetime clinical and economic outcomes for RT-CGM versus self-monitoring of blood glucose by fingerstick only. The base-case analysis was consistent with the RCT (RT-CGM for 2 weeks on/1 week off over 3 months). A scenario analysis simulated outcomes of an RT-CGM “refresher” after the active intervention of the RCT. Analyses used the IMS CORE Diabetes Model and were conducted from a US third-party payer perspective, including direct costs obtained from published sources and inflated to 2011 US dollars. Costs and health outcomes were discounted at 3% per annum. Results: Life expectancy (LE) and quality-adjusted life expectancy (QALE) from RT-CGM were 0.10 and 0.07, with a cost of $653/patient over a lifetime. Incremental LE and QALE from a “refresher” were 0.14 and 0.10, with a cost of $1312/patient over a lifetime, and incremental cost-effectiveness ratios were $9319 and $13 030 per LY and QALY gained. Conclusions: RT-CGM, as a self-care tool, is a cost-effective disease management option in the US for people with type 2 diabetes not on prandial insulin. Repeated use of RT-CGM may result in additional cost-effectiveness.