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., …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
• 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