Long‐term cost‐effectiveness of Dexcom G6 real‐time continuous glucose monitoring system in people with type 1 diabetes in Australia

Abstract

Introduction: Real-time continuous glucose monitoring (rt-CGM) allows patients with diabetes to adjust insulin dosing, potentially improving glucose control. This study aimed to compare the long-term cost-effectiveness of the Dexcom G6 rt-CGM device versus self-monitoring of blood glucose (SMBG) and flash glucose monitoring (FGM) in Australia in people with type 1 diabetes (T1D).Methods: Long-term costs and clinical outcomes were estimated using the CORE Diabetes Model. Clinical input data for the analysis of rt-CGM versus SMBG and FGM were sourced from the DIAMOND study and a network meta-analysis, respectively. Rt-CGM and FGM were associated with quality of life (QoL) benefits due to reduced fear of hypoglycaemia (FoH) and fingerstick testing. Analyses were performed over a lifetime time horizon from an Australian healthcare payer perspective, including direct costs from published data. Future costs and clinical outcomes were discounted at 5% per annum.Results: Rt-CGM was associated with an increased quality-adjusted life expectancy of 1.199 quality-adjusted life years (QALYs), increased mean total lifetime costs of AUD 21,596 and an incremental cost-effectiveness ratio (ICER) of AUD 18,020 per QALY gained compared with SMBG.Compared with FGM, rt-CGM was associated with an increased quality-adjusted life expectancy of 0.569 QALYs, increased mean total lifetime costs of AUD 11,064 and an ICER of AUD 19,455 per QALY gained. Key drivers of outcomes included HbA 1c benefits and QoL benefits associated with reduced FoH and fingerstick testing.Conclusions: Due to improved clinical outcomes and QoL gains rt-CGM is highly cost-effective compared with SMBG and FGM in people with T1D in Australia.

Cost‐utility of real‐time continuous glucose monitoring versus self‐monitoring of blood glucose and intermittently scanned continuous glucose monitoring in people with type 1 diabetes receiving multiple daily insulin injections in Denmark

“…It is possible that if the analyses had been performed from the societal perspective the ICURs may have been lower, as lost productivity costs in Denmark constituted 41% (EUR 1.77 billion) of the overall burden of T1D and T2D in 2011 11 . Moreover, the findings presented here align with those of a previous analysis in the Australian setting, in which rt‐CGM was projected to be cost‐effective compared with both SMBG and is‐CGM 29 …”

“…11 Moreover, the findings presented here align with those of a previous analysis in the Australian setting, in which rt-CGM was projected to be cost-effective compared with both SMBG and is-CGM. 29 The results from this study showed the health economic implications of the clinical outcomes from existing relevant studies. Specifically, randomized controlled trials and real-world evidence studies have shown that rt-CGM is associated with greater improvements in HbA1c, severe hypoglycaemia, and FoH relative to is-CGM.…”

The role of real‐time continuous glucose monitoring in diabetes management and how it should link to integrated personalized diabetes management

“…The cost of rtCGM and rtCGM‐linked technologies remains significant and therefore becomes a barrier to access for those who do not get coverage by insurance or meet the required criteria for access and reimbursement via their national health system. It is important to recognize that the cost associated with rtCGM in iPDM may be offset by long‐term benefits in terms of reduced diabetes‐related complications and hospital admissions 76–78 . Mitigating health disparities in rtCGM and rtCGM‐linked diabetes technology adoption across diverse sociodemographic areas and ethnicities remains a challenge, necessitating a prioritized focus on bridging this gap.…”

Long‐term cost‐effectiveness of Dexcom G6 real‐time continuous glucose monitoring system in people with type 1 diabetes in Australia: Response to letter from Hellmund, Richard and Welsh, Zoe

“…Long-term cost-effectiveness of Dexcom G6 real-time continuous glucose monitoring system in people with type 1 diabetes in Australia: Response to letter from Hellmund, Richard and Welsh, Zoe A letter from Hellmund, R. and Welsh, Z. was recently submitted to Diabetic Medicine expressing concern over the validity of utilizing the network meta-analysis (NMA) conducted by Pease et al (2020) in our paper entitled 'Longterm cost-effectiveness of Dexcom G6 real-time continuous glucose monitoring system in people with type 1 diabetes in Australia'. 1 The letter states the study relied on information for haemoglobin A1c (HbA1c) and quality of life (QoL) from Pease et al (2020). The Pease study is the largest NMA of its kind conducted to date, with inclusion of 52 eligible studies representing more than 3975 participants in the NMA.…”