Visual Abstract

Despite evidence pointing to clinical benefits of CGM, access has been limited by many state Medicaid plans. We assessed the budget impact of providing flash CGM to members with type 1 (T1D) or type 2 diabetes (T2D) taking multiple daily injections of insulin (MDI). We included the total US Medicaid and CHIP population. Using published data, we estimated rates of severe hypoglycemic events (SHE), diabetic ketoacidosis and other severe hyperglycemic events (DKA) as well as risk reduction from use of flash CGM for the various types of events and for reduction in HbA1c. Blood glucose monitoring (BGM) frequency was sourced from clinical trials. Costs for BGM, flash CGM, and unit costs for SHE and DKA and impact of HbA1c reductions were obtained from published literature and inflated to 2019. Increased use of the flash CGM in T1D and T2D MDI populations is almost cost-neutral from a Medicaid perspective. Increasing the population proportion using flash CGM (and the remainder using BGM) from a hypothetical share of 23% to 33% was associated with a $23 million overall decrease to the budget in one year. The analysis illustrates that although the unit cost of CGM is greater than blood glucose monitoring, cost offsets due to reductions in complications can lead to overall cost savings. This finding is important because health inequities, such as access to diabetes technology, are associated with poorer outcomes.


J. Frank: None. R. Hellmund: Employee; Self; Abbott Diabetes. N. Virdi: Employee; Self; Abbott Diabetes, Stock/Shareholder; Self; Johnson & Johnson. D. B. Blissett: Consultant; Self; Abbott Diabetes, Consultant; Spouse/Partner; Abbott Diabetes.

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