Purpose: Recent clinical evidence has shown that continuous glucose monitoring (CGM) devices can help reduce overall glycosylated hemoglobin (A1c) levels in adult patients, thereby decreasing the progression of complications of diabetes. However, the cost of CGM devices is significant for individuals and payers. The objective of this study is to determine the cost-effectiveness of CGM treatment with intensive insulin therapy compared to standard monitoring of blood glucose (SMBG) in adults with type 1 diabetes in the United States.
Method: A Markov cohort analysis was employed to model the long-term disease progression of 12 different diabetes disease states (including diabetes with no complications), using a cycle length of 1 year with a 33-year time horizon based on life expectancy. The analysis uses a societal perspective to model a population with a 20-year history of diabetes with mean age of 40. Costs are expressed in $US 2007, effectiveness in QALYs. Parameter estimates and their ranges were derived from the literature. Utility estimates were drawn from the EQ-5D catalogue developed by Sullivan et al. Probabilities were derived from the Diabetes Control and Complications Trial (DCCT), the United Kingdom Prospective Diabetes Study (UKPDS), and the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Costs and QALYs were discounted at 3% per year. Univariate and Multivariate probabilistic sensitivity analyses were conducted using 10,000 Monte Carlo simulations.
Result: Compared to SMBG, use of CGM with intensive insulin treatment resulted in an expected improvement in effectiveness of 0.49 QALYs, and an expected increase in cost of $24,435, resulting in an ICER of approximately $50,000/QALY. For a willingness-to-pay (WTP) of $100,000/QALY, CGM with intensive insulin therapy was cost-effective in 70% of the Monte Carlo simulations.
Conclusion: CGM with intensive insulin therapy improves effectiveness at a higher cost compared to SMBG with intensive insulin therapy, and appears to be cost-effective relative to other societal health interventions. CGM with intensive insulin therapy may be a cost-effective option for patients with additional resources for treatment, or higher A1c levels (e.g., > 8%). The cost-effectiveness of CGM also compares favorably to other health interventions commonly accepted by payers in the U.S.
Candidate for the Lee B. Lusted Student Prize Competition