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

Elliott, Rachel A; Rogers, Gabriel; Evans, Mark L.; Neupane, Sankalpa; Rayman, Gerry; Lumley, Sarah; Cranston, Iain; Narendran, Parth; Sutton, Christopher J.; Taxiarchi, Vicky P.; Burns, Matthew; Thabit, Hood; Wilmot, Emma G; Leelarathna, Lalantha; FLASH–UK Trial Study Group

Abstract

We previously showed that intermittently scanned continuous glucose monitoring (isCGM) reduces HbA1c at 24 weeks compared with self-monitoring of blood glucose with finger pricking (SMBG) in adults with type 1 diabetes and high HbA1c levels (58-97 mmol/mol [7.5%-11%]). We aim to assess the economic impact of isCGM compared with SMBG. Participant-level baseline and follow-up health status (EQ-5D-5L) and within-trial healthcare resource-use data were collected. Quality-adjusted life-years (QALYs) were derived at 24 weeks, adjusting for baseline EQ-5D-5L. Participant-level costs were generated. Using the IQVIA CORE Diabetes Model, economic analysis was performed from the National Health Service perspective over a lifetime horizon, discounted at 3.5%. Within-trial EQ-5D-5L showed non-significant adjusted incremental QALY gain of 0.006 (95% CI: -0.007 to 0.019) for isCGM compared with SMBG and an adjusted cost increase of £548 (95% CI: 381-714) per participant. The lifetime projected incremental cost (95% CI) of isCGM was £1954 (-5108 to 8904) with an incremental QALY (95% CI) gain of 0.436 (0.195-0.652) resulting in an incremental cost-per-QALY of £4477. In all subgroups, isCGM had an incremental cost-per-QALY better than £20,000 compared with SMBG; for people with baseline HbA1c >75 mmol/mol (9.0%), it was cost-saving. Sensitivity analysis suggested that isCGM remains cost-effective if its effectiveness lasts for at least 7 years. While isCGM is associated with increased short-term costs, compared with SMBG, its benefits in lowering HbA1c will lead to sufficient long-term health-gains and cost-savings to justify costs, so long as the effect lasts into the medium term. [Abstract copyright: © 2023 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.]

Citation

Elliott, R. A., Rogers, G., Evans, M. L., Neupane, S., Rayman, G., Lumley, S., Cranston, I., Narendran, P., Sutton, C. J., Taxiarchi, V. P., Burns, M., Thabit, H., Wilmot, E. G., Leelarathna, L., & FLASH–UK Trial Study Group. (2024). Estimating the cost-effectiveness of intermittently scanned continuous glucose monitoring in adults with type 1 diabetes in England. Diabetic Medicine, 41(3), Article e15232. https://doi.org/10.1111/dme.15232

• Journal Article Type: Article
• Acceptance Date: Sep 18, 2023
• Online Publication Date: Sep 26, 2023
• Publication Date: 2024-03
• Deposit Date: Feb 14, 2024
• Publicly Available Date: Feb 16, 2024
• Journal: Diabetic Medicine
• Print ISSN: 0742-3071
• Electronic ISSN: 1464-5491
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 41
• Issue: 3
• Article Number: e15232
• DOI: https://doi.org/10.1111/dme.15232
• Keywords: type one diabetes, glucose monitoring, intermittently scanned continuous glucose monitoring, randomised controlled trial, Cost-effectiveness analysis
• Public URL: https://nottingham-repository.worktribe.com/output/25952349
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1111/dme.15232