COST-EFFECTIVENESS OF G5 MOBILE CONTINUOUS GLUCOSE MONITORING (CGM) COMPARED TO SELF MONITORING BLOOD GLUCOSE (SMBG) ALONE FOR TYPE 1 DIABETES (T1DM) IN THE US

• Published in: Value in health 2017-05, Vol.20 (5), p.A245
• Main Authors: Chaugule, S, Graham, C
• Format: Article
• Language: English
• Subjects: Blood; Changes; Clinical effectiveness; Clinical research; Clinical trials; Cohort analysis; Cost analysis; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Disease prevention; Glucose; Glucose monitoring; Health care expenditures; Indirect costs; Medical treatment; Patients; Platinum; Quality adjusted life years; Sensitivity analysis; Type 1 diabetes mellitus; Willingness to pay
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.05.005

OBJECTIVES: To explore the cost-effectiveness of real-time G5 Mobile CGM compared to SMBG alone in Multiple Daily Injection (MDI) using T1DM patients in the US. METHODS: The IMS CORE Diabetes Model (CDM) (v. 9.0) was used to assess the long-term (50 year) cost-effectiveness of CGM (G5-Mobile) compared to SMBG alone for a T1DM cohort. Treatment effects and base-line characteristics of patients were sourced from the DIAMOND randomized controlled trial (RCT) while all other assumptions and costs were sourced from published research. The accuracy and clinical effectiveness of G5 Mobile CGM is the same as G4 Platinum CGM used in DIAMOND RCT. Base case (BC) assumptions included a) starting HbAlc 8.6%; b) change in HbAlc -1.1% for CGM group, -0.5% for SMBG alone; c) 50% reduction in severe hypoglycemic events (SHEs) and 26% conservative reduction in non-severe hypoglycemic events (NSHEs) for CGM group; d) dis-utilities of -0.0142 for NSHEs and SHEs not requiring medical intervention, and -0.047 for SHEs requiring medical resources. Treatment costs and outcomes were discounted at 3%. RESULTS: The incremental cost-effectiveness ratio (ICER) for base-case G5 Mobile vs. SMBG was $25,435/QALY. Sensitivity analyses showed that base-case results were sensitive to changes in percent reduction in hypoglycemic events and to changes in disutilities associated with these events. A 50% reduction in non-severe hypoglycemic events for CGM resulted in an ICER of $14,469/QALY. The base-case results were minimally impacted by changes in starting HbAlc levels, incorporation of indirect costs and changes in discount rate. CONCLUSIONS: The results of this analyses show that G5 Mobile CGM is cost effective within the T1DM population using MDI, assuming a US willingness-to-pay threshold of $100,000 per Quality-Adjusted Life Year (QALY). Thus, CGM should be used "first" before more expensive treatments such as sensor augmented pumps are used in Type 1 diabetes patients on multiple daily injections.