Aims: To evaluate the cost-effectiveness of continuous glucose monitoring (CGM) in type 1 diabetes (T1D) pregnancy.
Methods: Decision analytical models to compare T1D antenatal care with and without use of CGM. Probabilities, maternal health state utilities and healthcare resource utilization were obtained from individual patient-trial data. Costs and neonatal health state utilities were obtained from the literature. Primary outcome of interest was neonatal quality adjusted life years (QALY). The willingness to pay threshold was £30,000/QALY.
Results: Direct costs of CGM use were £2,045. From a neonatal perspective, CGM during was cost saving (- £2,613), and effective (75.43 vs. 73.77 QALYs), with an incremental cost effectiveness ratio (ICER) - 1,570.57/QALY (Figure 1). Sensitivity analyses demonstrated robustness of the model across ranges of variables including varying NICU care for preterm and term neonates, and health state utilities. From a maternal perspective, CGM was associated with additional cost (£330), but remained effective; QALYs 61.33 vs. 61.27 and ICER £5,508.00/QALY. CGM remained efficacious and the favored treatment strategy in the sensitivity analyses performed.
Conclusions: CGM use during T1D pregnancy is cost saving from a neonatal perspective and associated with improved cost effectiveness for both mother and neonate.
H.R. Murphy: Advisory Panel; Self; Medtronic MiniMed, Inc. D. Feig: Advisory Panel; Self; Medtronic. Speaker's Bureau; Self; Medtronic. N. Patel: None.
JDRF (17-2011-533); JDRF Canadian Clinical Trial Network (80-2010-585)