Cost-Effectiveness Analysis of Flash Glucose Monitoring System for People with Type 2 Diabetes Receiving Intensive Insulin Treatment

Abstract

Aims: For people with type 2 diabetes (T2D) on intensive insulin therapy, the use of flash continuous glucose monitoring (''flash monitoring'') is associated with improved average glucose control and/or reduced hypoglycemic exposure. This study assessed the cost-effectiveness of flash monitoring versus traditional blood glucose monitoring (BGM) in people with T2D using intensive insulin in the United Kingdom (UK). Methods: The IQVIA CORE Diabetes Model (IQVIA CDM; v9.0) was used to analyze the impact of flash monitoring versus BGM over a 40-year time horizon from the UK payer perspective. Model inputs included baseline characteristics, intervention effects, resource utilization, costs, and utilities, based on recently published literature and national databases. UK National Health Service reimbursed costs of flash monitoring and BGM were used. An intervention-related health utility was obtained from a time trade-off study. Alternative scenarios were explored to assess the impact of key assumptions on base case results. Results: In base-case analysis, flash monitoring compared with BGM resulted in an incremental cost of £5781 and an additional 0.47 qualityadjusted life years (QALYs). This provides an incremental cost-effectiveness ratio (ICER) of £12,309/QALY. HbA1c and the interventionrelated health utility were the key drivers of differentiation. All scenario analyses, including different discount rates, time horizons, effects on HbA1c and on the intervention-related health utility, as well as glycemic emergencies, generated ICERs of less than £20,000 per QALY. Conclusions: The consistent results across base case and a range of scenario analyses indicate that long-term flash glucose monitoring use is cost-effective compared with BGM in a UK population of T2D on intensive insulin therapy based on updated clinical effects and a cost-effectiveness threshold of £20,000-30,000 per QALY.

Cost–utility analysis of a flash continuous glucose monitoring system in the management of people with type 2 diabetes mellitus on basal insulin therapy—An Italian healthcare system perspective

“…Flash CGM has previously been shown to be a cost‐effective method of glucose monitoring for patients living with T2DM treated with MDI 46,47 . The present analysis shows that flash CGM is also cost effective for patients living with T2DM using only basal insulin.…”

“…Flash CGM has previously been shown to be a cost-effective method of glucose monitoring for patients living with T2DM treated with MDI. 46,47 The present analysis shows that flash CGM is also cost effective for patients living with T2DM using only basal insulin. In addition to increases in life-years, a major driver of the QALY gains seen with flash CGM is the reduction in NSHEs, reflecting the relative rarity of SHEs and DKA in this patient group.…”

A Podcast on the Use of CGM in Optimizing Type 2 Diabetes Management with Non-intensive Insulin Treatment in the Primary Care Setting

“…So everywhere you go people talk about the cost. They have, in some studies, looked at the use of CGM in the type 2 diabetes population with a focus on cost-effectiveness data [12,13]. I think that the initial focus in these studies was on intensive insulin therapy, and people with type 2 diabetes and multiple daily injections of insulin were compared with those with capillary blood glucose monitoring based on a lifetime horizon assumed to be 40 years, with the results showing some cost effectiveness with respect to using CGM [12,13].…”

“…They have, in some studies, looked at the use of CGM in the type 2 diabetes population with a focus on cost-effectiveness data [12,13]. I think that the initial focus in these studies was on intensive insulin therapy, and people with type 2 diabetes and multiple daily injections of insulin were compared with those with capillary blood glucose monitoring based on a lifetime horizon assumed to be 40 years, with the results showing some cost effectiveness with respect to using CGM [12,13]. Another single study also included cost due to productivity loss [12], and the use of intermittently-scanned CGM improved the quality-adjusted life years (QALY) for people with type 2 diabetes on intensive treatment, leading to a favourable incremental cost-effectiveness ratio (ICER) [14][15][16].…”