Background: A novel, factory-calibrated, flash continuous glucose monitoring system (flash CGM; FreeStyle Libre™ system) was approved by FDA in September 2017. The clinical benefit of flash CGM as a replacement for routine self-monitoring of blood glucose (SMBG) for people using MDI therapy has been assessed in RCTs in T1DM (Bolinder, 2016) and T2DM (Haak,2017). In both 6-month studies, people using flash CGM achieved a substantial reduction in hypoglycemia compared with those using SMBG, without increasing HbA1c or reducing the dose of insulin. A cost calculation based on ADA recommendations is presented, comparing the acquisition cost of flash CGM with routine SMBG.
Methods: The ADA Standards of Medical Care in Diabetes (2017) recommend between 6 to 10 glucose tests per day for people with diabetes who are using MDI therapy. List prices are $1.42 per strip and $36.00 per sensor. Sensor duration is up to 10 days. In the T1DM RCT, people using flash CGM also used 0.5 SMBG tests/day on average; in the T2DM RCT, people using flash CGM also used 0.3 SMBG tests/day. The calculation is based on a 30-day month.
Results: Monthly cost of 10 SMBG/day is $426.00 and of 6 SMBG/day is $255.60. This is compared with the monthly sensor cost of $108.00, to which should be added the monthly cost of occasional SMBG based on utilization in the RCTs: $21.30 per person per month (PPPM) for people with T1DM and $12.78 for people with T2DM. For those testing 6 times/day, flash CGM saves over $120 PPPM compared with SMBG and it saves over $290 PPPM for people testing 10 times/day. For people testing more than 3 times/day, flash CGM has a lower acquisition cost than SMBG.
Conclusion: For people with T1DM or T2DM who use MDI therapy, flash CGM has demonstrated improved adherence to the ADA recommendation as well as reduced acquisition cost when compared with routine SMBG.
R. Hellmund: Employee; Self; Abbott. Stock/Shareholder; Self; Abbott.