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Nationally Subsidized Continuous Glucose Monitoring: A Cost-Effectiveness Analysis

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posted on 2022-09-26, 19:46 authored by Anthony J Pease, Sophia Zoungas, Emily Callander, Timothy W Jones, Stephanie R Johnson, D Jane Holmes-Walker, David E Bloom, Elizabeth A Davis, Ella Zomer

  

Objective: The ‘Continuous Glucose Monitoring (CGM) Initiative’ recently introduced universal subsidized CGM funding for people with type 1 diabetes under 21 years of age in Australia. We thus aimed to evaluate the cost-effectiveness of this CGM Initiative based on national implementation data and project the economic impact of extending the subsidy to all age groups.

Methods: A patient-level Markov model was used to simulate disease progression for young people with type 1 diabetes and compared government subsidized access to CGM with the previous user-funded system. Three years of real-world clinical input data were sourced from analysis of the Australasian Diabetes Data Network and National Diabetes Services Scheme registries. Costs were considered from the Australian healthcare system’s perspective. An annual discount rate of 5% was applied to future costs and outcomes. Uncertainty was evaluated with probabilistic and deterministic sensitivity analyses.

 

Results: Government subsidized CGM funding for young people with type 1 diabetes compared to a completely user-funded model resulted in an incremental cost-effectiveness ratio (ICER) of AUD $39,518 per quality adjusted life year (QALY) gained. Most simulations (85%) were below the commonly accepted willingness-to-pay threshold of AUD $50,000 per QALY gained in Australia. Sensitivity analyses indicated that base-case results were robust, although strongly impacted by the cost of CGM devices. Extending the CGM Initiative throughout adulthood resulted in an ICER of AUD $34,890 per QALY gained.

Conclusions: Providing subsidized access to CGM for people with type 1 diabetes was found to be cost-effective compared to a completely user-funded model in Australia. 

Funding

AJP was supported by the Royal Australasian College of Physicians (RACP) / Diabetes Australia Research Establishment Fellowship from the RACP Foundation. This economic evaluation was developed through collaborations as part of the JDRF Global Centre of Excellence in diabetes research. Analysis of the linked Australasian Diabetes Data Network (ADDN) and National Diabetes Services Scheme (NDSS) datasets was supported by JDRF Australia (4-SRA-2016-169-M-B), the recipient of the Australian Research Council Special Research Initiative in Type 1 Juvenile Diabetes. The study funders had no role in study design, data collection, analysis, interpretation, or the manuscript preparation. The NDSS is an initiative of the Australian Government administered by Diabetes Australia.

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