medwireNews: Analysis of the DIAMOND study shows that continuous glucose monitoring (CGM) in patients with type 1 diabetes could be considered cost-effective, although this depends on the value for money threshold used.
The average 6-month direct and indirect costs of diabetes were US$ 11,032 (€ 8945) for the 105 CGM users in the DIAMOND trial and $ 7236 (€ 5867) for the 53 control participants, with the difference between the groups largely accounted for by the CGM device costs of $ 2554 (€ 2071) – averaging $ 15.20 (€ 12.32) per day. Offsetting this slightly was around a $ 100 (€ 81) reduction in glucose testing strip costs over the 6 months.
As previously reported, CGM led to a 1.1% reduction in glycated hemoglobin in this population of multiple daily injection users, compared with a 0.4% reduction in the control group. Extrapolating these findings to a lifetime, the researchers calculated the expected reductions in major diabetic complications associated with CGM use, including retinopathy, nephropathy, neuropathy, and cardiovascular complications.
Overall, GCM users gained 0.72 life–years and 0.54 quality-adjusted life–years (QALY), although the researchers stress that “[w]hether a 6-month treatment effect will be sustained over a person’s lifetime is not clear.”
Lifetime costs would be $ 55,208 (€ 44,766) greater with CGM use, giving an average incremental cost-effectiveness ratio (ICER) of $ 98,108 (€ 79,551) per QALY, report the researchers in Diabetes Care.
Wen Wan (University of Chicago, Illinois, USA) and study co-authors say that this is below the acceptable cost per QALY thresholds estimated from coverage decisions by US health insurance companies, reflecting “societal preferences” in the USA.
In the UK, however, NICE uses a cost per QALY threshold of £ 20,000 (€ 23,177; € 28,572) to £ 30,000 (€ 34,766; $ 42,858), which has not increased over time despite increases in NHS budget and productivity.
But Wan and team argue that “reasonable extended use of CGM components” would reduce its annual cost to $ 3271 (€ 2652), in turn reducing the ICER to $ 33,459 (€ 27,130) per QALY. Patients in DIAMOND used the Dexcom G4 system; real-world use of the G5 system produces an ICER of $ 41,464 (€ 33,621) per QALY, say the researchers.
medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group
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