FreeStyle Libre Flash Glucose Monitoring system for people with type 1 diabetes in the UK: a budget impact analysis

Abstract

IntroductionThis study aims to estimate the budget impact of increased uptake of the FreeStyle Libre Flash Glucose Monitoring system in people with type 1 diabetes mellitus (T1DM) in the UK.Research design and methodsA budget impact model was developed, applying real-world data collected in the Association of British Clinical Diabetologists (ABCD) FreeStyle Libre Nationwide Audit. Costs of diabetes glucose monitoring in a T1DM population (n=1790) using self-monitoring of blood glucose (SMBG) or the FreeStyle Libre system were compared with a scenario with increased use of the FreeStyle Libre system.ResultsThe ABCD audit demonstrates FreeStyle Libre system use reduces diabetes-related resource utilization. The cost analysis found that higher acquisition costs are offset by healthcare costs avoided (difference £168 per patient per year (PPPY)). Total costs were £1116 PPPY with FreeStyle Libre system compared with £948 PPPY with SMBG. In an average-sized UK local health economy, increasing FreeStyle Libre system uptake from 30% to 50% increased costs by 3.4% (£1 787 345–£1 847 618) and when increased to 70% increased by a further 3.3%.ConclusionIncreased uptake of the FreeStyle Libre system in the T1DM population marginally increases the cost to UK health economies and offers many system benefits.

Estimating the cost‐effectiveness of intermittently scanned continuous glucose monitoring in adults with type 1 diabetes in England

“…Another limitation of the economic evaluation was the need to incorporate hypoglycaemia data from sources other than the trial, so we made the conservative assumption that isCGM had no effect on SHE rates 18 . Event rates of non‐severe and nocturnal hypoglycaemic events were taken from the IMPACT trial because this trial provided a measure of relative occurrence between isCGM and SMBG in type 1 diabetes, although the cohort had better controlled disease than our cohort 19…”

“…It is important for policymakers and payers to have clinical and cost information when making reimbursement decisions. A budget impact analysis from a UK nationwide audit of people with type 1 diabetes suggested that isCGM is £168 per person per year more expensive to provide or purchase than SMBG, 18 with a small cost avoided (£21) due to changes in HbA1c. This provides some real‐world estimates of the budget impact of isCGM in the short‐term but does not allow policymakers and payers to understand the additional costs of isCGM in the context of longer term benefits, and does not focus on people with type 1 diabetes with high HbA1c.…”

“…This was applied to the Bilir overall SHE rate. The conservative assumption was made that isCGM had no effect on SHE rates 18 . We imported the event rates of non‐severe hypoglycaemic events from the IMPACT trial 19 (isCGM: 4897 per 100 patient years; SMBG: 6760 per 100 patient years).…”

“…The conservative assumption was made that isCGM had no effect on SHE rates. 18 We imported the event rates of nonsevere hypoglycaemic events from the IMPACT trial 19 (isCGM: 4897 per 100 patient years; SMBG: 6760 per 100 patient years). We imported the proportion of nocturnal hypoglycaemic events from the IMPACT trial of 0.25 for isCGM and 0.27 for SMBG.…”

“…Another limitation of the economic evaluation was the need to incorporate hypoglycaemia data from sources other than the trial, so we made the conservative assumption that isCGM had no effect on SHE rates. 18 Event rates of non-severe and nocturnal hypoglycaemic events were taken from the IMPACT trial because this trial provided a measure of relative occurrence between isCGM and SMBG in type 1 diabetes, although the cohort had better controlled disease than our cohort. 19 The key limitation of the within-trial analysis was that there was 15% missing data for costs and EQ-5D parameters, assumed to be missing at random, but this may have biased the results of the within-trial analysis, especially as there were more missing data in the SMBG arm.…”