Time in range (TIR) referres to the percentage of time that blood glucose levels stay within a pre-determined range for patients with diabetes. This study used simulation methods to quantify the long-term health benefit and economic return associated with the improvement of TIR in individuals with T2D. Individuals with self-reported T2D were identified from the 2017-2018 National Health and Nutrition Examination Survey as the target population for the simulation. A Markov model with three states (i.e., diabetes, diabetes with a history of cardiovascular disease (CVD) , death) was developed to calculate the 20-year cost, quality-adjusted life-years (QALY) gained, and cardiovascular disease (CVD) risk reduction under four scenarios: TIR >85%, 71-85%, 51-70%, and ≤50%. The risk of CVD and mortality were extracted from literature. CVD and mortality risk reduction associated with TIR improvement, as well as cost and QALY associated with each health state were all extracted from the literature. Costs were standardized to the 2021 US Dollar, and a 3.0% annual discount rate was used. A willingness-to-pay threshold of $50,000/QALY was used to determine cost-effectiveness. Compared with having a TIR <50%, improving the TIR to 51-70% was associated with an increase of 1.14 QALY and 1.20 life years, and a 5.86% relative risk reduction in CVD; improving the TIR to 71-85% was associated with an increase of 1.69 QALY and 1.46 life-years, and a 8.05% relative risk reduction in CVD; improving the TIR to >85% was associated with an increase of 3.QALY and 1.97 life-years, and a 14.89% relative risk reduction in CVD. The annual spending on treatment to improve the TIR from <50% to 51-70%, 71-85%, and >85% should be lower than $2,592, $3,082, and $4,120 respectively to make the treatment cost-effective. Improving TIR can potentially lead to a substantial health benefit. Our study qualified the maximum medical expenses allocated to improve the TIR while keeping the treatment cost-effective.


K.Alkhuzam: None. L.Shi: None. V.Fonseca: Consultant; Abbott, Asahi Kasei Corporation, Bayer AG, Novo Nordisk, Sanofi, Research Support; Fractyl Health, Inc., Jaguar Gene Therapy, Stock/Shareholder; Abbott, Amgen Inc., BRAVO4Health, Mellitus Health. Y.Zhang: None. J.Guo: None. H.Shao: Board Member; BRAVO4HEALTH, LLC.

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