The Cost-Effectiveness of Continuous Glucose Monitoring in Type 1 Diabetes

  1. The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group

Abstract

Objective: Continuous glucose monitoring (CGM) has been found to improve glucose control in type 1 diabetes patients. We estimated the cost-effectiveness of CGM versus standard glucose monitoring in type 1 diabetes.

Research Design and Methods: This societal cost-effectiveness analysis was conducted in trial populations where CGM has produced a significant glycemic benefit (HbA1C ≥7.0% cohort- adults ≥25 years, HbA1C<7.0% cohort- all ages). Trial data were integrated into a simulation model of type 1 diabetes complications. The main outcome was the cost per quality-adjusted life year (QALY) gained.

Results: During the trials, CGM patients experienced an immediate quality of life benefit (HbA1C≥7.0% cohort : 0.70 quality-adjusted life weeks (QALWs) p=0.49; HbA1C<7.0% cohort: 1.39 QALWs, p=0.04) and improved glucose control. In the long-term CEA for the HbA1C≥7.0% cohort, CGM was projected to reduce the lifetime probability of microvascular complications; the average gain in QALYs was 0.60. The incremental cost effectiveness ratio (ICER) was $98,679/QALY (95% confidence intervals (CI), −60K (4th quadrant), −87K (2nd quadrant)). For the HbA1C<7.0% cohort, the average gain in QALYs was 1.11. The ICER was $78,943/QALY (95% CI, 15k (1st quadrant), −291K (2nd quadrant)). If the benefit of CGM had been limited to the long-term effects of improved glucose control, the ICER would exceed $700,000/QALY. If test strip use had been 2 per day with CGM long-term, the ICER for CGM would improve significantly.

Conclusions: Long-term projections indicate that CGM is cost-effective among type 1 patients at the $100,000/QALY threshold, although considerable uncertainty surrounds these estimates.

Footnotes

    • Received November 3, 2009.
    • Accepted March 8, 2010.

This Article

  1. Diabetes Care
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