Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.
Diabetologia. 2024 Apr;67(4):650-662. doi: 10.1007/s00125-023-06084-2. Epub 2024 Jan 18.
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.
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.
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.
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.
目的/假设：本研究旨在评估 Dexcom G6 实时连续血糖监测（rtCGM）与带警报功能与 FreeStyle Libre 1 间歇性扫描连续血糖监测（isCGM）相比，在比利时的 1 型糖尿病成人中的长期成本效益。
使用 IQVIA CORE 糖尿病模型来评估成本效益。模拟基线队列的输入数据来自随机对照试验 ALERTT1（ClinicalTrials.gov.注册号：NCT03772600）。参与者的年龄为 42.9 ± 14.1 岁（平均值 ± 标准差），基线 HbA 为 57.8 ± 9.5 mmol/mol（7.4 ± 0.9%）。根据 6 个月的组间平均差异，使用 rtCGM 的参与者 HbA 降低了 3.6 mmol/mol（0.36 个百分点）。在基本情况下，根据比利时报销系统，rtCGM 和 isCGM 的价格均为 3.92 欧元/天（不含增值税）。分析从比利时医疗保健支付者的角度在终身时间范围内进行。健康结果以质量调整生命年来表示。使用概率和单向敏感性分析来考虑参数不确定性。
在基本情况下，rtCGM 优于 isCGM，导致糖尿病相关并发症成本降低和健康状况改善。有利于 rtCGM 的主要驱动因素是较低的 HbA、较少的严重低血糖事件和减少对低血糖的恐惧。在广泛的单向敏感性分析下，结果是稳健的。在 rtCGM 价格为 5.11 欧元/天（价格上涨 30.4%）或 12.34 欧元/天（价格上涨 214.8%）的模型中，rtCGM 分别为成本中性或达到每质量调整生命年 40,000 欧元的增量成本效益比。
结论/解释：在比利时的 1 型糖尿病成人中，当价格相同时，Dexcom G6 rtCGM 带警报功能与不带警报的 FreeStyle Libre 1 isCGM 相比具有经济和临床效益，并且似乎是一种具有成本效益的血糖监测方式。试验注册 ClinicalTrials.gov NCT03772600。
