ClinicoEconomics and Outcomes Research (Nov 2024)
Cost-Utility of Real-Time Continuous Glucose Monitoring versus Self-Monitoring of Blood Glucose in People with Insulin-Treated Type 2 Diabetes in Spain
Abstract
Juan Francisco Merino-Torres,1 Sabrina Ilham,2 Hamza Alshannaq,2,3 Richard F Pollock,4 Waqas Ahmed,4 Gregory J Norman2 1Endocrinology and Nutrition Department, Health Research Institute La Fe, University Hospital La Fe. Department of Medicine, University of Valencia, Valencia, Spain; 2Dexcom, San Diego, CA, USA; 3University of Cincinnati College of Medicine, Cincinnati, OH, USA; 4Covalence Research Ltd, Harpenden, UKCorrespondence: Richard F Pollock, Covalence Research Ltd., Rivers Lodge, West Common, AL5 2JD, Harpenden, UK, Tel +44 20 8638 6525, Email [email protected]: Management of advanced type 2 diabetes (T2D) typically involves daily insulin therapy alongside frequent blood glucose monitoring, as treatments such as oral antidiabetic agents are therapeutically insufficient. Real-time continuous glucose monitoring (rt-CGM) has been shown to facilitate greater reductions in glycated hemoglobin (HbA1c) levels and improvements in patient satisfaction relative to self-monitoring of blood glucose (SMBG). This study aimed to investigate the cost-utility of rt-CGM versus SMBG in Spanish patients with insulin-treated T2D..Methods: The analysis was conducted using the IQVIA Core Diabetes Model (CDM V9.5). Baseline characteristics of the simulated patient cohort and treatment efficacy data were sourced from a large-scale, United States-based retrospective cohort study. Costs were obtained from Spanish sources and inflated to 2022 Euros (EUR) where required. A remaining lifetime horizon (maximum 50 years) was used, alongside an annual discount rate of 3% for future costs and health effects. A willingness-to-pay (WTP) threshold of EUR 30,000 per quality-adjusted life year (QALY) was adopted, based on precedent across previous cost–effectiveness studies set in Spain. A Spanish payer perspective was adopted.Results: Over patient lifetimes, rt-CGM yielded 9.933 QALYs, versus 8.997 QALYs with SMBG, corresponding to a 0.937 QALY gain with rt-CGM. Total costs in the rt-CGM arm were EUR 2347 higher with rt-CGM versus SMBG (EUR 125,365 versus EUR 123,017). The base case incremental cost–utility ratio was therefore EUR 2506 per QALY gained, substantially lower than the WTP threshold of EUR 30,000 per QALY. The analysis also projected a reduction in cumulative incidence of ophthalmic, renal, neurological, and cardiovascular events in rt-CGM users, with reductions of 16.03%, 13.07%, 7.34%, and 9.09%, respectively.Conclusion: Compared to SMBG, rt-CGM is highly likely to be a cost-effective intervention for patients living with insulin-treated T2D in Spain.Keywords: continuous glucose monitoring, CGM, cost-effectiveness, hypoglycaemia, health economics, type 2 diabetes
