Abstract

We have shown that intermittent “doses” of RT-CGM (unblinded use) were associated with a sustained reduction in A1C over 52 weeks as compared with daily self-monitoring of blood glucose (SMBG) (RT-CGM: -1.1% vs. SMBG: -0.5%) in patients with T2DM not on prandial insulin. The current analysis modelled the cost-effectiveness of RT-CGM of this type of intervention. Using the validated IMS CORE Diabetes Model, we projected the lifetime clinical and economic outcomes for RT-CGM vs. SMBG. In base-case analysis, the frequency and duration of RT-CGM use was modelled after the clinical study, i.e. 2 weeks on/1 week off RT-CGM for 12 weeks. A scenario analysis was conducted to simulate the additional costs and health benefits of a second “dose” of RT-CGM in year 2 assuming maintenance of the A1C achieved at the end of year 1. In both analyses we assumed that A1C converged within 21 months following the active intervention. Analyses were conducted from a U.S. third-party payer perspective, including only direct costs obtained from published sources and inflated to US$2011. Outcomes were discounted at 3% per annum, with sensitivity analyses on time horizons and key clinical variables. Base-case: RT-CGM results in an incremental 0.09 life years (LY) and 0.07 quality-adjusted life years (QALY) with an incremental cost of $250.The cost of RT-CGM is offset by lower SMBG and reduced complication rates. The incremental cost-effectiveness ratios were $2,903 per LY gained, and $3,735 per QALY gained. Scenario analysis: similar use of RT-CGM in year 2 results in a greater QALY gain (0.165 or 2 months), at an incremental cost of $1,217, with the cost-effectiveness ratio of $10,071 per QALY gained. In summary, the results show that RT-CGM is a cost-effective disease management option in the US for people with T2DM not on prandial insulin. Repeated use of RT-CGM may result in additional cost-effective health benefits, due to longer-term impact on physiological parameters.