Cost-utility analysis of a flash continuous glucose monitoring system in the management of people with type 2 diabetes mellitus on basal insulin therapy-An Italian healthcare system perspective

Diabetes Obes Metab. 2024 Sep;26(9):3633-3641. doi: 10.1111/dom.15703. Epub 2024 Jun 10.

Abstract

Aims: To assess the cost-utility of the FreeStyle Libre flash continuous glucose monitoring (CGM) system from an Italian healthcare system perspective, when compared with self-monitoring of blood glucose (SMBG) in people living with type 2 diabetes mellitus (T2DM) receiving basal insulin.

Materials and methods: A patient-level microsimulation model was run using Microsoft Excel for 10 000 patients over a lifetime horizon, with 3.0% discounting for costs and utilities. Inputs were based on clinical trials and real-world evidence, with patient characteristics reflecting Italian population data. The effect of flash CGM was modelled as a persistent 0.8% reduction in glycated haemoglobin versus SMBG. Costs (€ 2023) and disutilities were applied to glucose monitoring, diabetes complications, severe hypoglycaemia, and diabetic ketoacidosis. The health outcome was measured as quality-adjusted life-years (QALYs).

Results: Direct costs were €5338 higher with flash CGM than with SMBG. Flash CGM was associated with 0.51 more QALYs than SMBG, giving an incremental cost-effectiveness ratio (ICER) of €10 556/QALY. Scenario analysis ICERs ranged from €3825/QALY to €26 737/QALY. In probabilistic analysis, flash CGM was 100% likely to be cost effective at willingness-to-pay thresholds > €20 000/QALY.

Conclusions: From an Italian healthcare system perspective, flash CGM is cost effective compared with SMBG for people living with T2DM on basal insulin.

Keywords: basal insulin; cost‐effectiveness; glycaemic control; health economics.

MeSH terms

  • Aged
  • Blood Glucose / analysis
  • Blood Glucose / metabolism
  • Blood Glucose Self-Monitoring* / economics
  • Blood Glucose Self-Monitoring* / instrumentation
  • Blood Glucose Self-Monitoring* / methods
  • Continuous Glucose Monitoring
  • Cost-Benefit Analysis*
  • Diabetes Mellitus, Type 2* / blood
  • Diabetes Mellitus, Type 2* / drug therapy
  • Diabetes Mellitus, Type 2* / economics
  • Female
  • Glycated Hemoglobin / analysis
  • Glycated Hemoglobin / metabolism
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemia / economics
  • Hypoglycemia / prevention & control
  • Hypoglycemic Agents* / economics
  • Hypoglycemic Agents* / therapeutic use
  • Insulin / administration & dosage
  • Insulin / economics
  • Insulin / therapeutic use
  • Italy
  • Male
  • Middle Aged
  • Quality-Adjusted Life Years*

Substances

  • Hypoglycemic Agents
  • Insulin
  • Blood Glucose
  • Glycated Hemoglobin