Introduction: Diabetes and its complications cost the US healthcare system $412.9 billion in 2022. The use of RT-CGM systems in diabetes management is associated with improvements in glycemic outcomes for people with insulin-treated T2D. We aim to investigate the cost-effectiveness of RT-CGM systems from a US payor perspective.

Methods: Using the IQVIA Core Diabetes Model v10.0, we projected clinical outcomes and direct medical costs over a lifetime horizon from a US payor perspective. Cohort characteristics and clinical inputs were sourced from a large US retrospective cohort study. Clinical parameters include an A1C effect of -0.56% favoring RT-CGM, severe hypoglycemic events rates of 0.04 and 0 Per Person-Year (PPY) for SMBG and RT-CGM, respectively, and DKA rates of 0.025 and 0 PPY, respectively. The costs of glucose monitoring are based on Medicare pricing and 80% reimbursement (HCPCS codes A4239 and A4253). A utility for the avoidance of finger sticks (0.03) and fear of hypoglycemia reduction (0.025) were applied to users of RT-CGM.

Results: The model projects RT-CGM users to have higher quality-adjusted life years by 0.769 with incremental costs of $16,019, and an incremental cost-effectiveness ratio (ICER) of 20,825, which is below the willingness to pay threshold (WTP) of $50,000. The relative reduction in the total number of events due to RT-CGM use for diabetes eye, renal, neuropathy, and cardiovascular complications was 17.0%, 20.0%, 8.7%, and 2.4% respectively. RT-CGM remained cost-effective under the $50,000 WTP even when its cost was increased by 85% (+$2,097). Sensitivity analysis for reducing RT-CGM costs by 10%, 20%, and 30% resulted in ICERs of 17,425, 14,020, and 10,616 respectively.

Conclusions: RT-CGM systems are cost-effective and project cost-savings due to a reduction in acute diabetes events, and microvascular and macrovascular complications. Our findings support access to RT-CGM in US payor policies.

Disclosure

H. Alshannaq: Employee; Dexcom, Inc. Stock/Shareholder; Unicycive Therapeutics. G.J. Norman: Employee; Dexcom, Inc. P.M. Lynch: Employee; Dexcom, Inc. Stock/Shareholder; Dexcom, Inc.

© 2024 by the American Diabetes Association
2024
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