An Economic Evaluation of Continuous Glucose Monitoring for People with Type 1 Diabetes and Impaired Awareness of Hypoglycaemia within North West London Clinical Commissioning Groups in England

Abstract

To assess the economic impact of providing real time continuous glucose monitoring (CGM) for people with type 1 diabetes (T1D) and impaired awareness of hypoglycaemia (IAH) within North West (NW) London clinical commissioning groups (CCGs). Methods: The eligible population for CGM and inputs for the economic budget impact model developed were derived from published data. The model includes cost of CGM; cost savings associated with lower hypoglycaemia related hospital admissions, accidents and emergency visits; self-monitoring of blood glucose (SMBG) strip usage; and glycated haemoglobin (HbA1c) reduction-related avoided complications and insulin pump use. Results: The cost of CGM for T1D-IAH (n=3,036) in the first year is £10,770,671 and in the fourth year is £11,329,095. The combined cost off-sets related to reduced hypoglycaemia admissions, SMBG strip usage and complications are £8,116,912 and £8,741,026 in years one and four, respectively. The net budget impact within the NW London CCGs is £2,653,760; £2,588,068 in years one and four respectively. Conclusions: Introduction of CGM for T1D-IAH patients will have a minimal budget impact on NW London CCGs, driven by cost of CGM and offsets from lower hypoglycaemia-related costs, reduced SMBG strip usage, avoided HbA1c-related complications and lower insulin pump use.

Cost-effectiveness of health technologies in adults with type 1 diabetes: a systematic review and narrative synthesis

“…Flash glucose monitoring was reported to provide $474 AUD ($333 USD) cost savings over 1 year compared to SMBG and heterogeneous insulin delivery methods in the UK [28], based on the 'Novel Glucose-Sensing Technology and Hypoglycemia in Type 1 Diabetes: a Multicentre, Non-masked, Randomised Controlled Trial' (IMPACT study) [29]. A budget impact analysis in the UK reported CGM to have 'minimal budget impact' compared to SMBG when insulin delivery modality was either CSII or MDI [30]. The real option analysis approach with cash flow simulation of a cohort in Finland reported that integrated CSII and CGM systems provide $1,000,792 AUD ($704,029 USD) cost savings in comparison to MDI with SMBG over a lifetime [25].…”

“…Herman et al utilised CSII and MDI treatment effects based on the intensive and conventional treatment arms of the landmark diabetes control and complications trial (DCCT) published in 1995 which may not reflect contemporary management strategies or HbA1c treatment effects [24,57]. Economic evaluations that compared CGM to SMBG modelled treatment effects for HbA1c as a reduction of 0.23% (2.5 mmol/mol) to 0.6% (6.6 mmol/mol) [30,33]. Three studies that reported CGM was not cost-effective modelled a treatment effect for HbA1c less than 0.5% (5.5 mmol/mol) from the authors' own respective meta-analyses [14,17,33].…”

Orthodontics in patients with significant medical co-morbidities

“…DM consists of a group of metabolic diseases that are characterised by hyperglycaemia due to a total, or relative, lack of insulin secretion and/or insulin resistance (Al-Maskari et al, 2011). The prevalence of type 1 DM is 187.7 per 100,000 (Chaugule et al, 2017) and type 2 DM is 5260 per 100,000 (Zghebi et al, 2017). Current classifications describe four sub-types of DM:…”

Continuous Glucose Monitoring: A Brief Review for Primary Care Practitioners

“…A cost-effectiveness analysis of data from the DIAMOND study showed that, in adults with T1D and elevated HbA1c (≥ 7.5%), CGM increased costs compared with SMBG but was a lifetime cost-effective intervention when clinical benefits (HbA1c reduction, daily strip use, and frequency of non-severe hypoglycemia) were taken into account [110]. Similarly, for high-risk patients with T1D and impaired hypoglycemia awareness, the economic impact of CGM is counteracted by lower hypoglycemia-related costs, reduced SMBG strip use, avoidance of HbA1c-related complications, and reduced insulin pump use [111]. CGM is also known to be cost effective in the management of patients with T2D not treated with prandial insulin [112].…”