Journal Article

Cost-effectiveness of continuous glucose monitoring and intensive insulin therapy for type 1 diabetes

Campbell, Jonathan D, Nair, Kavita V, Ellis, Samuel L, McQueen, R Brett, Sullivan, Patrick W

2011

Overview

Background Our objective was to determine the cost-effectiveness of Continuous Glucose Monitoring (CGM) technology with intensive insulin therapy compared to self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes in the United States. Methods A Markov cohort analysis was used to model the long-term disease progression of 12 different diabetes disease states, using a cycle length of 1 year with a 33-year time horizon. The analysis uses a societal perspective to model a population with a 20-year history of diabetes with mean age of 40. Costs are expressed in $US 2007, effectiveness in quality-adjusted life years (QALYs). Parameter estimates and their ranges were derived from the literature. Utility estimates were drawn from the EQ-5D catalogue. Probabilities were derived from the Diabetes Control and Complications Trial (DCCT), the United Kingdom Prospective Diabetes Study (UKPDS), and the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Costs and QALYs were discounted at 3% per year. Univariate and Multivariate probabilistic sensitivity analyses were conducted using 10,000 Monte Carlo simulations. Results Compared to SMBG, use of CGM with intensive insulin treatment resulted in an expected improvement in effectiveness of 0.52 QALYs, and an expected increase in cost of $23,552, resulting in an ICER of approximately $45,033/QALY. For a willingness-to-pay (WTP) of $100,000/QALY, CGM with intensive insulin therapy was cost-effective in 70% of the Monte Carlo simulations. Conclusions CGM with intensive insulin therapy appears to be cost-effective relative to SMBG and other societal health interventions.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Care and treatment / Continuous Glucose Monitoring / Cost-effectiveness analysis / Cost-utility analysis / Economic aspects / Glucose monitors / Health Administration / Health Economics / Health Services Research / Insulin / Medicine / Medicine & Public Health / Pharmacoeconomics and Health Outcomes / Public Health / Quality of Life Research / Self-Monitoring of Blood Glucose / Type 1 diabetes