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Cost-effectiveness of Continuous Glucose Monitoring for Adults With Type 1 Diabetes Compared With Self-Monitoring of Blood Glucose: The DIAMOND Randomized Trial. Diabetes Care 2018 06;41(6):1227-1234

Date

04/14/2018

Pubmed ID

29650803

Pubmed Central ID

PMC5961392

DOI

10.2337/dc17-1821

Abstract

OBJECTIVE: This study evaluated the societal cost-effectiveness of continuous glucose monitoring (CGM) in patients with type 1 diabetes (T1D) using multiple insulin injections.

RESEARCH DESIGN AND METHODS: In the Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes (DIAMOND) trial, 158 patients with T1D and HbA1c ≥7.5% were randomized in a 2:1 ratio to CGM or control. Participants were surveyed at baseline and 6 months. Within-trial and lifetime cost-effectiveness analyses were conducted. A modified Sheffield T1D policy model was used to simulate T1D complications. The main outcome was cost per quality-adjusted life-year (QALY) gained.

RESULTS: Within the 6-month trial, the CGM group had similar QALYs to the control group (0.462 ± 0.05 vs. 0.455 ± 0.06 years, P = 0.61). The total 6-month costs were $11,032 (CGM) vs. $7,236 (control). The CGM group experienced reductions in HbA1c (0.60 ± 0.74% difference in difference [DiD]), P < 0.01), the daily rate of nonsevere hypoglycemia events (0.07 DiD, P = 0.013), and daily test strip use (0.55 ± 1.5 DiD, P = 0.04) compared with the control group. In the lifetime analysis, CGM was projected to reduce the risk of T1D complications and increase QALYs by 0.54. The incremental cost-effectiveness ratio (ICER) was $98,108 per QALY for the overall population. By extending sensor use from 7 to 10 days in a real-world scenario, the ICER was reduced to $33,459 per QALY.

CONCLUSIONS: For adults with T1D using multiple insulin injections and still experiencing suboptimal glycemic control, CGM is cost-effective at the willingness-to-pay threshold of $100,000 per QALY, with improved glucose control and reductions in nonsevere hypoglycemia.

Author List

Wan W, Skandari MR, Minc A, Nathan AG, Winn A, Zarei P, O'Grady M, Huang ES

Author

Aaron Winn PhD Assistant Professor in the School of Pharmacy Administration department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Blood Glucose
Blood Glucose Self-Monitoring
Cost-Benefit Analysis
Diabetes Mellitus, Type 1
Female
Humans
Hypoglycemia
Hypoglycemic Agents
Insulin
Male
Middle Aged
Monitoring, Ambulatory
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a