Real-time continuous glucose monitoring vs self-monitoring of blood glucose in distinct multi-ethnic cohorts of patients living with insulin-treated type 2 diabetes in the United States: A cost-utility analysis from a Medicare perspective.

Abstract

Background: For individuals living with type 2 diabetes (T2D) requiring insulin therapy, the use of real-time continuous glucose monitoring (rt-CGM) yields significant clinical benefits relative to self-monitoring of blood glucose (SMBG).

Objective: To determine the cost-utility of rt-CGM vs SMBG in a US setting, for a simulated cohort of individuals with T2D receiving insulin therapy.

Methods: The IQVIA CORE Diabetes Model version 10 was employed for this analysis, which was conducted over a remaining lifetime horizon. Clinical effectiveness data were sourced from a large-scale, retrospective cohort study set in the United States. Direct medical costs were obtained from a range of published studies for the Medicare setting and by using relevant Healthcare Common Procedure Coding System codes for Medicare. A willingness- to-pay (WTP) threshold of $50,000 per quality-adjusted life-year (QALY) was used, with future effects and costs discounted at 3% per annum. The base case was conducted from a Medicare perspective. One-way and probabilistic sensitivity analyses were performed.

Results: From a Medicare perspective, the use of rt-CGM yielded mean total direct medical costs of $107,215, alongside 7.584 QALYs over a time horizon of 50 years. Comparatively, SMBG was associated with lower mean total direct medical costs of $100,116 while yielding only 6.818 QALYs. The final incremental cost-utility ratio was $9,265 per QALY gained, showing that at a WTP threshold of $50,000 per QALY gained, rt-CGM was cost-effective relative to SMBG. Results from the 1-way sensitivity analysis showed rt-CGM to be dominant when a commercial plan perspective was adopted and more cost-effective for 100% Black, Native American, and Hispanic cohorts when compared with a 100% White cohort.

Conclusions: In a simulated cohort representative of individuals living with T2D and receiving insulin therapy, rt-CGM may be cost-effective compared with SMBG from a Medicare perspective. Therefore, rt-CGM plausibly possesses the potential to address existing racial and ethnic disparities in diabetes-related outcomes for patients within the United States.