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Randomized Controlled Trial
. 2010 Jun;33(6):1269-74.
doi: 10.2337/dc09-2042. Epub 2010 Mar 23.

The cost-effectiveness of continuous glucose monitoring in type 1 diabetes

Elbert S Huang  1 , Michael O'Grady, Anirban Basu, Aaron Winn, Priya John, Joyce Lee, David Meltzer, Craig Kollman, Lori Laffel, William Tamborlane, Stuart Weinzimer, Tim Wysocki; Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group
Affiliations
Randomized Controlled Trial

The cost-effectiveness of continuous glucose monitoring in type 1 diabetes

Elbert S Huang et al. Diabetes Care. 2010 Jun.

Erratum in

  • Diabetes Care. 2010 Sep;33(9):2129

Abstract

Objective: Continuous glucose monitoring (CGM) has been found to improve glucose control in type 1 diabetic patients. We estimated the cost-effectiveness of CGM versus standard glucose monitoring in type 1 diabetes. RESEARCH DESIGN AND METHODS This societal cost-effectiveness analysis (CEA) was conducted in trial populations in which CGM has produced a significant glycemic benefit (A1C >or=7.0% in a cohort of adults aged >or=25 years and A1C <7.0% in a cohort of all ages). Trial data were integrated into a simulation model of type 1 diabetes complications. The main outcome was the cost per quality-adjusted life-year (QALY) gained.

Results: During the trials, CGM patients experienced an immediate quality-of-life benefit (A1C >or=7.0% cohort: 0.70 quality-adjusted life-weeks [QALWs], P = 0.49; A1C <7.0% cohort: 1.39 QALWs, P = 0.04) and improved glucose control. In the long-term, CEA for the A1C >or=7.0% cohort, CGM was projected to reduce the lifetime probability of microvascular complications; the average gain in QALYs was 0.60. The incremental cost-effectiveness ratio (ICER) was $98,679/QALY (95% CI -60,000 [fourth quadrant] to -87,000 [second quadrant]). For the A1C <7.0% cohort, the average gain in QALYs was 1.11. The ICER was $78,943/QALY (15,000 [first quadrant] to -291,000 [second quadrant]). If the benefit of CGM had been limited to the long-term effects of improved glucose control, the ICER would exceed $700,000/QALY. If test strip use had been two per day with CGM long term the ICER for CGM would improve significantly.

Conclusions: Long-term projections indicate that CGM is cost-effective among type 1 diabetic patients at the $100,000/QALY threshold, although considerable uncertainty surrounds these estimates.

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