Background: Type 1 diabetes (T1D) patients with impaired awareness of hypoglycemia (IAH) face higher risk of severe hypoglycemic events. Continuous glucose monitoring (CGM) has been found to prevent severe hypoglycemic events in this population (van Beers 2016) compared to self-monitoring of blood glucose (SMBG). This study aimed to evaluate the annual cost of a hypothetical CGM intervention that would be cost-effective vs. SMBG in the United Kingdom (UK) according to a willingness-to-pay threshold of £30,000/QALY.
Methods: The IQVIA Core Diabetes Model was used to run analyses over multiple time horizons (50-, 5-, and 1-year to test impact of assuming continued intervention effects over time) with an IAH population reflecting the IN CONTROL study (van Beers 2016). This study evaluated impact of CGM on hypoglycemia in an IAH population. CGM intervention effects included: odds ratio 0.45 for severe hypoglycemic events (requiring third party intervention); 0.03 utility benefit associated with reduced finger prick requirements of CGM (Matza 2016). HbA1c was assumed equivalent between CGM and SMBG. All other inputs reflected published literature and/or public tariffs, with costs in 2018 GBP. Threshold analyses were performed to identify the annual cost of intervention associated with incremental cost-effectiveness ratio (ICER) threshold £30,000/QALY over each time horizon. Sensitivity analyses were also performed on key input variables.
Results: Over 50 years, up to £1,354 could be spent annually on CGM to achieve a £30,000/QALY ICER threshold. With shorter time horizons, the annual intervention cost to achieve cost-effectiveness was slightly lower, ranging from £1,344 over 5 years to £1,301 for a 1-year horizon.
Conclusions: Based on recent evidence that CGM reduces severe hypoglycemia in IAH T1D patients, CGM can be considered cost-effective in the UK at costs per year of up to approximately £1,350.
S. Bilir: Employee; Self; IQVIA. C. Campbell: Consultant; Self; Abbott. R. Hellmund: Employee; Self; Abbott Laboratories. Stock/Shareholder; Self; Abbott Laboratories. J. Munakata: Employee; Self; IQVIA.