Cost-utility analysis of Dexcom G6 real-time continuous glucose monitoring versus FreeStyle Libre 1 intermittently scanned continuous glucose monitoring in adults with type 1 diabetes in Belgium

Margaretha M Visser, Astrid Van Muylder, Sara Charleer, John J Isitt, Stéphane Roze, Christophe De Block, Toon Maes, Gerd Vanhaverbeke, Frank Nobels, Bart Keymeulen, Chantal Mathieu, Jeroen Luyten, Pieter Gillard, Nick Verhaeghe

Research output: Contribution to journalArticlepeer-review

Abstract

Aims/hypothesis: The aim of this study was to assess the long-term cost-effectiveness of Dexcom G6 real-time continuous glucose monitoring (rtCGM) with alert functionality compared with FreeStyle Libre 1 intermittently scanned continuous glucose monitoring (isCGM) without alerts in adults with type 1 diabetes in Belgium. Methods: The IQVIA CORE Diabetes Model was used to estimate cost-effectiveness. Input data for the simulated baseline cohort were sourced from the randomised ALERTT1 trial (ClinicalTrials.gov. registration no. NCT03772600). The age of the participants was 42.9 ± 14.1 years (mean ± SD), and the baseline HbA 1c was 57.8 ± 9.5 mmol/mol (7.4 ± 0.9%). Participants using rtCGM showed a reduction in HbA 1c of 3.6 mmol/mol (0.36 percentage points) based on the 6-month mean between-group difference. In the base case, both rtCGM and isCGM were priced at €3.92/day (excluding value-added tax [VAT]) according to the Belgian reimbursement system. The analysis was performed from a Belgian healthcare payer perspective over a lifetime time horizon. Health outcomes were expressed as quality-adjusted life years. Probabilistic and one-way sensitivity analyses were used to account for parameter uncertainty. Results: In the base case, rtCGM dominated isCGM, resulting in lower diabetes-related complication costs and better health outcomes. The associated main drivers favouring rtCGM were lower HbA 1c, fewer severe hypoglycaemic events and reduced fear of hypoglycaemia. The results were robust under a wide range of one-way sensitivity analyses. In models where the price of rtCGM is €5.11/day (a price increase of 30.4%) or €12.34/day (a price increase of 214.8%), rtCGM was cost-neutral or reached an incremental cost-effectiveness ratio of €40,000 per quality-adjusted life year, respectively. Conclusions/interpretation: When priced similarly, Dexcom G6 rtCGM with alert functionality has both economic and clinical benefits compared with FreeStyle Libre 1 isCGM without alerts in adults with type 1 diabetes in Belgium, and appears to be a cost-effective glucose monitoring modality. Trial registration ClinicalTrials.gov NCT03772600 Graphical Abstract: [Figure not available: see fulltext.]

Original languageEnglish
Pages (from-to)650-662
Number of pages13
JournalDiabetologia
Volume67
Early online date18 Jan 2024
DOIs
Publication statusPublished - Apr 2024

Bibliographical note

Funding Information:
University Hospitals Leuven (sponsor of the ALERTT1 trial) acted as sponsor of this study and received a research grant from Dexcom. Representatives of Dexcom reviewed the manuscript, but had no role in the study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit for publication. The authors would like to thank all the local investigators and their teams for collecting the data during the ALERTT1 trial. Some of the data were presented as an abstract at The Official Journal of ATTD Advanced Technologies & Treatments for Diabetes Conference in 2023.

Publisher Copyright:
© 2024, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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