Population-level impact and cost-effectiveness of continuous glucose monitoring and intermittently-scanned continuous glucose monitoring technologies for adults with type 1 diabetes in Canada: a modelling study

Objective:  Maintaining healthy glucose levels is critical for the management of type 1 diabetes (T1D), but the most efficacious and cost-effective approach (capillary self-monitoring of blood glucose [SMBG], continuous or intermittently-scanned glucose monitoring [CGM, isCGM]) is not clear. We modelled the population-level impact of these three glucose-monitoring systems on diabetes-related complications, mortality, and cost-effectiveness in adults with T1D in Canada.

Research Design and Methods: We used a Markov cost-effectiveness model based on 9 complication states for adults aged 18-64 years with T1D.  We performed the cost-effectiveness analysis from a single payer health care system perspective over a 20-year horizon; assuming a willingness-to-pay threshold of $50,000 per quality adjusted life year (QALY).  Primary outcomes were the number of complications and deaths, and the incremental cost-effectiveness ratio (ICER) of CGM and isCGM relative to SMBG.

Results: An initial cohort of 180,000 with baseline HbA1c of 8.1% was used to represent all Canadians aged 18-64 with T1D. Universal SMBG use was associated with ~11,200 people (6.2%) living without complications and ~89,400 (49.7%) deaths after 20 years. Universal CGM use was associated with an additional ~7,400 (4.1%) people living complication-free and ~11,500 (6.4%) fewer deaths compared to SMBG, while universal isCGM use was associated with ~3,400 (1.9%) more people living complication-free and ~4,600 (2.6%) fewer deaths.  Relative to SMBG, CGM and isCGM had ICERs of $35,017/QALY and $17,488/QALY, respectively.

Conclusions:  Universal use of CGM or isCGM in the Canadian T1D population is anticipated to reduce diabetes-related complications and mortality at an acceptable cost-effectiveness threshold.