A COA was performed comparing clinical cost offsets for an rt-CGM system with SMBG calibration compared with SMBG alone in people with T1D (n=2,000 per country) and uncontrolled glycemia, in eight countries over a one-year period.
Clinical effects for HbA1c reduction from rt-CGM and SMBG were -1.0% and -0.4%, respectively, taken from a recently published RCT (Beck, 2017). HbA1c reductions for rt-CGM and SMBG were converted into an economic benefit based on a US study (Wagner, 2001), adjusted for the Organization for Economic Cooperation and Development (OECD) healthcare purchasing power parity and 2019 exchange rates for non-US countries. Reduced hospitalization rates for severe hypoglycemia (SH; -73%) and diabetic ketoacidosis (DKA; -80%) were taken from a recent observational study in Belgium where SMBG was used in the year prior to countrywide reimbursement of rt-CGM and followed for one year (Charleer, 2018). Costs attributable to HbA1c reduction, SH and DKA hospitalizations were taken from country-specific published literature and inflated to 2019 values.
The reduction in SH hospitalization rate using rt-CGM over SMBG yielded an annual 491 fewer SH hospitalizations per country. The reduction in DKA hospitalization rate using rt-CGM over SMBG yielded an annual 201 fewer DKA hospitalizations per country. Projected annual cost offsets per person with T1D using rt-CGM over SMBG are as follows: Australia, $1,216-$1,435; Canada, $1,195-$1,404; France, €953-€1,096; Germany, €911-€1,079; Italy, €960-€1,064; Spain, €722-€821; UK, £605-£720; USA, $1,535-$1,867.
Our modelling study demonstrates potential clinical and economic benefits for rt-CGM compared with SMBG in people with T1D from eight countries.