Cost-Effectiveness of FreeStyle Libre for Glucose Self-Management Among People with Diabetes Mellitus: A Canadian Private Payer Perspective

Stewart Harris; Sal Cimino; Yen Nguyen; Kirk Szafranski; Yeesha Poon

doi:10.1007/s13300-024-01677-5

Cost-Effectiveness of FreeStyle Libre for Glucose Self-Management Among People with Diabetes Mellitus: A Canadian Private Payer Perspective

Diabetes Ther. 2024 Dec 17. doi: 10.1007/s13300-024-01677-5. Online ahead of print.

Authors

Stewart Harris¹, Sal Cimino², Yen Nguyen³, Kirk Szafranski⁴, Yeesha Poon⁵

Affiliations

¹ Western University, London, ON, Canada.
² MORSE Consulting, Toronto, ON, Canada.
³ Synergyx Consulting, Montréal, QC, Canada.
⁴ Eversana, Burlington, ON, Canada.
⁵ Abbott Diabetes Care, 6925 Century Ave, Suite 100, Mississauga, ON, L5N 7K2, Canada. yeesha.poon@abbott.com.

PMID: 39688778
DOI: 10.1007/s13300-024-01677-5

Abstract

Introduction: For people living with diabetes, effective glucose monitoring is a key component in diabetes care, helping to reduce disease burden, complications, and healthcare utilization. Sensor-based glucose monitoring systems, which can provide more comprehensive information about glucose levels than capillary-based self-monitoring of blood glucose (SMBG), are becoming established among people living with diabetes. The objective of this study was to assess the cost-effectiveness of glucose monitoring with FreeStyle Libre systems, compared with SMBG, from the perspective of a Canadian private payer.

Methods: The analysis used the validated, person-level microsimulation model DEDUCE (Determination of Diabetes Utilities, Costs, and Effects). Analyses were conducted separately for populations of people with type 1 and type 2 diabetes mellitus (T1DM; T2DM), with time horizons of 40 and 25 years, respectively. T2DM treatment was assumed to be 84% non-insulin, 10% basal insulin, and 6% multiple daily injections of insulin. The effect of FreeStyle Libre was modeled as reductions versus SMBG in glycated hemoglobin level (T1DM, - 0.42%; insulin-treated T2DM, - 0.59%; non-insulin-treated T2DM, - 0.3%) and in acute diabetic events (hypoglycemia and diabetic ketoacidosis). Costs (in 2023 Canadian dollars (Can$)) and utilities were discounted at 1.5%. Outcomes were assessed as costs and quality-adjusted life years (QALYs).

Results: In both populations, FreeStyle Libre was dominant to SMBG, providing more QALYs at a lower cost (T1DM: + 1.25 QALYs, - Can$32,287 costs; T2DM: + 0.48 QALYs, - Can$8091 costs). Reductions were seen in the cumulative incidence of all complications (except blindness in the T1DM analysis). FreeStyle Libre was dominant to SMBG in all scenarios tested. Probabilistic sensitivity analysis showed that FreeStyle Libre had a 100% probability of being dominant to SMBG for T1DM and a 91% probability of being dominant for T2DM.

Conclusion: This economic analysis shows that, from a Canadian private payer perspective, FreeStyle Libre is cost-effective compared with SMBG for all people living with diabetes.

Keywords: Continuous glucose monitoring; Cost-effectiveness analysis; FreeStyle Libre system; Type 1 diabetes mellitus; Type 2 diabetes mellitus.

Plain language summary

Glucose monitoring is important for people living with diabetes. Effective glucose monitoring can reduce the risk of hypoglycemia (low blood sugar), diabetic ketoacidosis (a potentially life-threatening complication which occurs when the body has low insulin and high blood sugar levels), and long-term complications. This can be done using finger sticks and test strips or sensor-based devices such as the FreeStyle Libre systems. In this study, we modeled the effect of FreeStyle Libre use in persons living with type 1 or type 2 diabetes mellitus in Canada using the DEDUCE economic model. In both analyses, FreeStyle Libre use was predicted to lead to better outcomes (measured as quality-adjusted life years—a measure of health which combines life expectancy with quality of life) for people living with diabetes while reducing costs.