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Cost-effectiveness of RT-CGM versus SMBG in the UK

Type 1 diabetes – September 2020 digest

Real-time continuous glucose monitoring is a cost-effective management option compared with self-monitoring of blood glucose, based on a willingness-to-pay threshold of £20 000 per quality-adjusted life-year gained.

This analysis was conducted to assess the long-term health-economic outcomes associated with use of the Dexcom G6 real-time continuous glucose monitoring (RT-CGM) system versus self-monitoring of blood glucose (SMBG) in people with type 1 diabetes in the UK. The IQVIA CORE Diabetes Model, a validated computer simulation model to project long-term outcomes, was used.

The analysis used data from the DIAMOND study, in which 158 people with type 1 diabetes were randomised to RT-CGM or SMBG for 24 weeks, which demonstrated improvements in HbA1c and hypoglycaemia with use of the former. Costs were derived from published UK sources and assumed a mean SMBG usage of 4.6 fingerprick tests per day.

Over a lifetime, RT-CGM was estimated to increase the number of quality-adjusted life-years (QALYs) by 1.49, at an increased lifetime cost of £14 234. This represented an incremental cost-effectiveness ratio of £9558 per QALY gained. The higher costs of RT-CGM were largely derived from direct costs of the device; however, they were somewhat countered by reduced healthcare costs associated with lower rates of hypoglycaemia and long-term diabetes complications.

The principal limitation of this study was the use of short-term data (under 1 year) to project long-term outcomes. Emerging data suggest that the benefits of RT-CGM persist over 3 years of follow-up; however, longer-term data are not yet available due to the recency of the latest generation of RT-CGM devices. Nonetheless, the authors conclude that RT-CGM is a cost-effective management option compared with SMBG, based on a willingness-to-pay threshold of £20 000 per QALY gained. The study was funded by Dexcom.

Roze S, Isitt J, Smith-Palmer J et al (2020) Long-term cost-effectiveness of Dexcom G6 real-time continuous glucose monitoring versus self-monitoring of blood glucose in patients with type 1 diabetes in the U.K. Diabetes Care 9 Jul [epub ahead of print]. https://doi.org/10.2337/dc19-2213

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