CGM With Insulin Injections Could Be Cost-Effective in Diabetes

Miriam E Tucker

April 13, 2018

Use of continuous glucose monitoring (CGM) could prove to be cost-effective in real-world use among people with type 1 diabetes managed with multiple daily insulin injections, new research suggests.

The findings, from the DIAMOND trial, were published online April 12 in Diabetes Care by Wen Wan, PhD, a statistician in the Division of General Internal Medicine at the University of Chicago, Illinois, and colleagues.

Previous data demonstrating CGM cost-effectiveness in type 1 diabetes were based on use with insulin pumps, whereas more than 65% of patients still use multiple daily insulin injections, the authors point out.   

In contrast, the new study focused on adults with type 1 diabetes with suboptimal glycemic control taking multiple daily insulin injections. Despite higher within-trial costs, use of CGM for 6 months proved to be cost-effective at the willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY) gained, with improved glucose control and a reduced rate of nonsevere hypoglycemia.

"With real-world use, CGM can be highly cost-effective," Wan and colleagues write.

Lifetime Extrapolation Shows Benefits of CGM

In the unblinded multicenter trial, 158 patients with type 1 diabetes and HbA1c ≥ 7.5% using multiple daily insulin injections were randomized to CGM or usual care with fingerstick testing (about four daily strip tests). A total of 102 patients in the CGM group and 53 controls completed the 6-month visit.

Average 6-month total costs were $11,032 for the CGM group and $7,236 for controls (P < .01), with the difference primarily attributable to CGM device costs of $2554. Cost of daily glucose test strip use was significantly reduced with CGM versus without CGM use ($612 vs $750, P = .04).

Patients who used CGM compared with controls showed significantly greater decreases in HbA1c (-1.0 vs -.04 percentage points) and daily rate of nonsevere hypoglycemic episodes (-0.12 vs -0.06, P = .02).

There was no significant difference in the percentage of patients who experienced severe hypoglycemic episodes (2% with CGM vs 4% of controls). 

A lifetime analysis indicated that CGM would be expected to reduce the average incidence rates of most major type 1 diabetes complications and extend life expectancy by an average of 0.72 years.

In the lifetime extrapolation, patients gained 0.54 QALYs and CGM was cost-effective, with an incremental cost-effectiveness ratio (ICER) of $98,108 per QALY.

And with extension of CGM use from 7 to 10 days — as is the case with the recently approved Dexcom G6 — the annual cost of CGM is reduced to $3271, and the ICER decreases to $33,459 per QALY.

"Our study provides an important expanded view on the contemporary economic value of CGM in type 1 diabetes," Wan and colleagues write, given the still-predominant use of injection rather than pump therapy.

"Our study, based on the DIAMOND trial, confirms that CGM is equally valuable in this large and important segment of the population with type 1 diabetes."

The study was funded by a grant from Dexcom and the Chicago Center for Diabetes Translation Research, National Institute of Diabetes and Digestive and Kidney Diseases. Wan was supported by the Royster Society of Fellows at the University of North Carolina at Chapel Hill.

Diabetes Care. Published online April 12, 2018. Abstract

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