Cost-Effectiveness of Flash Glucose Monitoring for the Management of Patients with Type 1 and Patients with Type 2 Diabetes in China

Abstract

Introduction: To compare the cost-effectiveness of flash glucose monitoring versus selfmonitoring of blood glucose/point of care testing (SMBG/POCT) in both patients with type 1 and patients with type 2 diabetes (T1D/T2D) receiving insulin therapy. Methods: The IQVIA CORE Diabetes Model (version 9.5) was used to project the lifetime costs and health outcomes of flash glucose monitoring and SMBG/POCT from a Chinese societal perspective. We considered both hospital and individual version flash glucose monitoring to reflect the clinical practice in China. The clinical inputs leveraged the outcomes from both clinical trials and real-world studies. Cohort characteristics, intervention costs, treatment-related disutility and mortality were extracted from the literature. We also conducted scenario analyses and probabilistic sensitivity analyses to test the robustness of results. Results: Compared with SMBG/POCT using efficacy results from clinical trial, flash glucose monitoring brought the incremental costs of Chinese yuan (CNY) 58,021 and CNY 90,997 and additional quality-adjusted life years (QALYs) of 1.22 and 0.65 for patients with T1D and patients with T2D, respectively. According to the ''WHO-CHOICE threshold'' of three times the gross domestic product per capita in China (CNY 217,341 in 2020) as cost-effectiveness threshold, flash glucose monitoring was costeffective for both patients with T1D and patients with T2D with incremental cost-effectiveness ratios (ICER) of CNY 47,636 and CNY 140,297 per QALY gained, respectively. According to the real-world effectiveness data, flash glucose monitoring was dominant for patients with T1D (lower costs and better effectiveness) and cost-effective for patients with T2D with an ICER of CNY 124,169 per QALY gained compared with SMBG/POCT. Scenario analyses and probabilistic sensitivity analyses confirmed the robustness of the results.Xinran Zhao and Jian Ming contributed to the work equally and should be regarded as co-first authors.

Personalizing the Use of a Intermittently Scanned Continuous Glucose Monitoring Device in Individuals With Type 1 Diabetes: A Cost-Effectiveness Perspective in the Netherlands (FLARE-NL 9)

“…5 A recent study which also used the IQVIA Core Diabetes Model, showed that isCGM was dominant compared to SMBG in China. 14 None of these studies estimated subgroupspecific ICERs, as we did in this study. The different time horizon and lower FSL costs could explain the more favorable ICER found in the Swedish study compared with our study.…”

Comparing the effectiveness of continuous subcutaneous insulin infusion with multiple daily insulin injection for patients with type 1 diabetes mellitus evaluated by retrospective continuous glucose monitoring: A real-world data analysis

“…In China, the individual version of flash glucose monitoring (Free-Style Libre; Abbott Diabetes Care, Witney, UK) is the most conventional type of CGMs for patients with T1DM caring out of hospitals. A recent research indicated that flash glucose monitoring could be considered as a cost-effective strategy compared with self-monitoring of blood glucose for Chinese T1DM patients receiving insulin therapy ( 40 ). Therefore, flash glucose monitoring can be a promising option to improve glycemic control in Chinese T1DM patients undergoing CSII therapy.…”

Cost-utility of real-time continuous glucose monitoring versus self-monitoring of blood glucose in people with insulin-treated Type II diabetes in France

“…Patients who had Type II diabetes without complications were assumed to have a baseline utility value of 0.785, which was obtained from Beaudet et al [ 25 ], and used as the default CDM value [ 26 ]. Quality of life utilities and disutilities associated with diabetes-related complications were obtained from Beaudet et al [ 25 ] and Zhao et al [ 27 ] ( Supplementary Table 1 ). The disutility associated with DKA [ 27 ] (0.0367) was obtained from a study of people with Type 1 diabetes experiencing DKA, as data on DKA disutilities in people with Type II diabetes could not be identified.…”

“…Quality of life utilities and disutilities associated with diabetes-related complications were obtained from Beaudet et al [ 25 ] and Zhao et al [ 27 ] ( Supplementary Table 1 ). The disutility associated with DKA [ 27 ] (0.0367) was obtained from a study of people with Type 1 diabetes experiencing DKA, as data on DKA disutilities in people with Type II diabetes could not be identified. Based on the avoidance of daily and frequent fingerstick testing, an additional annual utility benefit of 0.03 (sourced from a time trade-off study [ 28 ]) was applied in the rt-CGM arm.…”