Diabetes management for PwT2D on MDI requires access to timely glucose readings to inform treatment decisions and avoid acute events like severe hypoglycemia (SHE) and Diabetic Ketoacidosis (DKA). CGM systems have different features that can impact glycemic outcomes and disease complications and costs. There is a gap in the literature on the cost-effectiveness of rt-CGM vs is-CGM systems. We conducted lifetime projections of disease outcomes and costs from a US payer perspective using the IQVIA Core Diabetes Model v9.5+. Cohort characteristics and clinical inputs were sourced from the DIAMOND T2D and REPLACE RCTs. Applying Bucher's adjusted indirect comparison method resulted in an HbA1c effect of -0.33 favoring rt-CGM, SHE incidence rates of 0.014 and 0 Per Person-Year (PPY) for is-CGM and rt-CGM, respectively, and DKA rates were estimated using Time-Above-Range (0.0313 and 0 PPY, respectively). The cost of both CGM systems is based on Medicare pricing and 80% reimbursement (HCPCS code A4239). A utility for fear of hypoglycemia (FoH) reduction was applied from the ALERTT1 RCT. The model associates rt-CGM use with reduced eye (-5.64%), renal (-7.42%), neural (-4.08%), and cardiovascular (-2.56%) complications compared to is-CGM. It projects rt-CGM users to have higher quality-adjusted life years (QALYs) by 0.454 with cost savings of -$1,355, and an incremental cost-effectiveness ratio of -$2,983/QALY. Rt-CGM remained cost-effective under the $50,000 willingness-to-pay threshold even when its cost was increased by 70% (+$1,713). Scenario analysis with 50% lower FoH utility, SHE, and DKA rates reduced QALYs gained to 0.264. Our analysis suggests that rt-CGM is cost-saving and cost-effective vs is-CGM in PwT2D on MDI in the US and can inform US payers of the economic value of different CGM systems. Disclosure H. Alshannaq: Employee; Dexcom, Inc., Other Relationship; Vertex Pharmaceuticals Incorporated. G. J. Norman: Employee; Dexcom, Inc. P. M. Lynch: Employee; Dexcom, Inc., Stock/Shareholder; Dexcom, Inc.

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A health economic analysis was conducted to determine the cost-effectiveness of a real-time continuous glucose monitoring (rt-CGM) system versus self-monitoring of blood glucose (SMBG) in Type 2 diabetes (T2D) patients treated with insulin. The IQVIA CORE diabetes model was utilized for the analysis. Clinical data were sourced from a US retrospective cohort study of adult T2D patients on insulin and adapted to Canada. The baseline mean age (SD) of the cohort was 61 years (13.2) and proportion of male 49%. Mean baseline HbA1c for the cohort was 8.3% (67 mmol/mol) . Patients using rt-CGM were assumed to have a reduction in HbA1c of -0.56% based on the mean difference between groups after 12-months follow-up. A quality-of-life (QoL) benefit associated with reduced finger-stick testing was applied. The analysis was conducted from the Canadian Agency for Drugs and Technologies in Health perspective over a lifetime horizon. The rt-CGM system was associated with an incremental gain of 0.97 quality-adjusted life years (QALYs) compared with SMBG (mean [SD] 10.35 [3.08] versus 9.375 [2.85] QALYs) . Total mean [SD] lifetime costs were CAN$ 17,223 higher with rt-CGM (CAN$ 206,284 [121,493] versus 189,061 [129.680]) , resulting in an incremental cost-effectiveness ratio of CAN$ 17,652 per QALY gained. Sensitivity analyses demonstrated findings were sensitive to changes in QoL, HbA1c, younger patient cohorts, and rt-CGM cost. Varying rt-CGM cost to -25% of base case yielded an ICER of CAN$ 3,512, and varying rt-CGM cost to -50% of base case the ICER becomes dominant over SMBG. For T2D patients on insulin, rt-CGM was associated with significant clinical outcomes and is a cost-effective management option relative to SMBG based on a willingness-to-pay threshold of CAN$ 50,000 per QALY gained. Disclosure J.J.Isitt: Consultant; Dexcom, Inc. S.Roze: None. G.Cogswell: None. P.M.Lynch: Employee; Dexcom, Inc., Stock/Shareholder; Dexcom, Inc.