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Diabetologia
Apr, 2024;67 (4): 650-662.

Cost-utility analysis of Dexcom G6 real-time continuous glucose monitoring versus FreeStyle Libre 1 intermittently scanned continuous glucose monitoring in adults with type 1 diabetes in Belgium.

Margaretha M Visser, Astrid Van Muylder, Sara Charleer, John J Isitt, Stéphane Roze, Christophe De Block, Toon Maes, Gerd Vanhaverbeke, Frank Nobels, Bart Keymeulen, Chantal Mathieu, Jeroen Luyten, Pieter Gillard, Nick Verhaeghe
Author Information
  1. Margaretha M Visser: Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium. ORCID
  2. Astrid Van Muylder: Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium. ORCID
  3. Sara Charleer: Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
  4. John J Isitt: Vyoo Agency, San Diego, CA, USA.
  5. Stéphane Roze: Vyoo Agency, Lyon, France.
  6. Christophe De Block: Department of Endocrinology-Diabetology-Metabolism, University Hospital Antwerp, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
  7. Toon Maes: Department of Endocrinology, Imeldaziekenhuis Bonheiden, Bonheiden, Belgium.
  8. Gerd Vanhaverbeke: Department of Endocrinology, AZ Groeninge, Kortrijk, Belgium.
  9. Frank Nobels: Department of Endocrinology, OLV Hospital Aalst, Aalst, Belgium.
  10. Bart Keymeulen: Academic Hospital and Diabetes Research Centre, Vrije Universiteit Brussel, Brussels, Belgium.
  11. Chantal Mathieu: Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
  12. Jeroen Luyten: Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.
  13. Pieter Gillard: Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium. pieter.gillard@uzleuven.be. ORCID
  14. Nick Verhaeghe: Research Institute for Work and Society, KU Leuven, Leuven, Belgium. ORCID
PMID: 38236409 DOI: 10.1007/s00125-023-06084-2

Abstract

AIMS/HYPOTHESIS: The aim of this study was to assess the long-term cost-effectiveness of Dexcom G6 real-time continuous glucose monitoring (rtCGM) with alert functionality compared with FreeStyle Libre 1 intermittently scanned continuous glucose monitoring (isCGM) without alerts in adults with type 1 diabetes in Belgium.
METHODS: The IQVIA CORE Diabetes Model was used to estimate cost-effectiveness. Input data for the simulated baseline cohort were sourced from the randomised ALERTT1 trial (ClinicalTrials.gov.
REGISTRATION NO: NCT03772600). The age of the participants was 42.9 ± 14.1 years (mean ± SD), and the baseline HbA was 57.8 ± 9.5 mmol/mol (7.4 ± 0.9%). Participants using rtCGM showed a reduction in HbA of 3.6 mmol/mol (0.36 percentage points) based on the 6-month mean between-group difference. In the base case, both rtCGM and isCGM were priced at €3.92/day (excluding value-added tax [VAT]) according to the Belgian reimbursement system. The analysis was performed from a Belgian healthcare payer perspective over a lifetime time horizon. Health outcomes were expressed as quality-adjusted life years. Probabilistic and one-way sensitivity analyses were used to account for parameter uncertainty.
RESULTS: In the base case, rtCGM dominated isCGM, resulting in lower diabetes-related complication costs and better health outcomes. The associated main drivers favouring rtCGM were lower HbA, fewer severe hypoglycaemic events and reduced fear of hypoglycaemia. The results were robust under a wide range of one-way sensitivity analyses. In models where the price of rtCGM is €5.11/day (a price increase of 30.4%) or €12.34/day (a price increase of 214.8%), rtCGM was cost-neutral or reached an incremental cost-effectiveness ratio of €40,000 per quality-adjusted life year, respectively.
CONCLUSIONS/INTERPRETATION: When priced similarly, Dexcom G6 rtCGM with alert functionality has both economic and clinical benefits compared with FreeStyle Libre 1 isCGM without alerts in adults with type 1 diabetes in Belgium, and appears to be a cost-effective glucose monitoring modality. Trial registration ClinicalTrials.gov NCT03772600.

Keywords

Cost-effectiveness Cost–utility analysis Economic evaluation Intermittently scanned continuous glucose monitoring Real-time continuous glucose monitoring Type 1 diabetes

Associated Data

ClinicalTrials.gov | NCT03772600

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Grants

  1. OUS-2018-011/Dexcom

MeSH Term

Adult
Humans
Middle Aged
Diabetes Mellitus, Type 1
Cost-Benefit Analysis
Blood Glucose Self-Monitoring
Blood Glucose
Belgium
Continuous Glucose Monitoring
Hypoglycemic Agents

Chemicals

Blood Glucose
Hypoglycemic Agents
Journal Article
Article has an altmetric score of 1

Word Cloud

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