Vyoo Agency, San Diego, California, USA.
Vyoo Agency, Lyon, France.
Diabet Med. 2022 Jul;39(7):e14831. doi: 10.1111/dme.14831. Epub 2022 Mar 25.
Real-time continuous glucose monitoring (rt-CGM) allows patients with diabetes to adjust insulin dosing, potentially improving glucose control. This study aimed to compare the long-term cost-effectiveness of the Dexcom G6 rt-CGM device versus self-monitoring of blood glucose (SMBG) and flash glucose monitoring (FGM) in Australia in people with type 1 diabetes (T1D).
Long-term costs and clinical outcomes were estimated using the CORE Diabetes Model. Clinical input data for the analysis of rt-CGM versus SMBG and FGM were sourced from the DIAMOND study and a network meta-analysis, respectively. Rt-CGM and FGM were associated with quality of life (QoL) benefits due to reduced fear of hypoglycaemia (FoH) and fingerstick testing. Analyses were performed over a lifetime time horizon from an Australian healthcare payer perspective, including direct costs from published data. Future costs and clinical outcomes were discounted at 5% per annum.
Rt-CGM was associated with an increased quality-adjusted life expectancy of 1.199 quality-adjusted life years (QALYs), increased mean total lifetime costs of AUD 21,596 and an incremental cost-effectiveness ratio (ICER) of AUD 18,020 per QALY gained compared with SMBG. Compared with FGM, rt-CGM was associated with an increased quality-adjusted life expectancy of 0.569 QALYs, increased mean total lifetime costs of AUD 11,064 and an ICER of AUD 19,455 per QALY gained. Key drivers of outcomes included HbA benefits and QoL benefits associated with reduced FoH and fingerstick testing.
Due to improved clinical outcomes and QoL gains rt-CGM is highly cost-effective compared with SMBG and FGM in people with T1D in Australia.
实时连续血糖监测（rt-CGM）可使糖尿病患者调整胰岛素剂量，从而有可能改善血糖控制。本研究旨在比较 Dexcom G6 rt-CGM 设备与澳大利亚 1 型糖尿病（T1D）患者自我血糖监测（SMBG）和闪光血糖监测（FGM）的长期成本效益。
使用 CORE Diabetes Model 估算长期成本和临床结果。rt-CGM 与 SMBG 和 FGM 的分析的临床输入数据分别来自 DIAMOND 研究和网络荟萃分析。由于减少了对低血糖的恐惧（FoH）和指尖测试，rt-CGM 和 FGM 与生活质量（QoL）的益处相关。分析从澳大利亚医疗保健支付者的角度在终生时间范围内进行，包括来自已发表数据的直接成本。未来的成本和临床结果以每年 5%的贴现率进行贴现。
与 SMBG 相比，rt-CGM 与增加的 1.199 个质量调整生命年（QALY）的质量调整生命预期相关，增加了平均终生总成本 21596 澳元，增量成本效益比（ICER）为每获得一个 QALY 增加 18020 澳元。与 FGM 相比，rt-CGM 与增加的 0.569 个质量调整生命年（QALY）的质量调整生命预期相关，增加了平均终生总成本 11064 澳元，每获得一个 QALY 的增量成本效益比（ICER）为 19455 澳元。结果的主要驱动因素包括 HbA 获益和与减少 FoH 和指尖测试相关的 QoL 获益。
由于临床结果和 QoL 的改善，与 SMBG 和 FGM 相比，rt-CGM 在澳大利亚的 T1D 患者中具有很高的成本效益。
