COST-UTILITY ANALYSIS IN A UK SETTING OF SELF MONITORING OF BLOOD GLUCOSE IN PATIENTS WITH TYPE-2 DIABETES

Palmer AJ1, Dinneen S2, Gavin III JR3, Gray A4, Herman WH5, Karter AJ6
1CORE - Center for Outcomes Research, Binningen, Switzerland; 2National University of Ireland, Galway, Galway, Ireland; 3Emory University School of Medicine and Morehouse School of Medicine, Fairburn, GA, USA; 4University of Oxford, Oxford, UK; 5University of Michigan, Ann Arbor, MI, USA; 6Kaiser Permanente, Oakland, CA, USA

OBJECTIVES: Self monitoring of blood glucose (SMBG) has been shown to improve glycemic control of type 2 diabetes in previous studies (HbA1c improved by 0.3-0.6% with SMBG versus no SMBG, depending on treatment received) However, the cost of testing supplies is high and cost-effectiveness has not been evaluated. METHODS: A validated model (CORE Diabetes model) projected improvements in lifetime qualityadjusted life years (QALY), long-term costs, and cost-effectiveness of SMBG versus no SMBG. Markov/Monte Carlo modeling simulated progression of complications (cardiovascular, neuropathy, renal and eye disease). Transition probabilities and HbA1c-dependent adjustments came from
UKPDS and other major studies. Costs of complications came from published sources. Direct costs of diabetes complications and SMBG were projected over patients' lifetimes from a UK National Health Service perspective. Outcomes were discounted at 3.5% annually. Sensitivity analysis was performed. RESULTS: Depending on the type of diabetes treatment (diet and exercise/oral medications/insulin), improvements in glycemic control with SMBG improved discounted QALYs by 0.12±0.14 to 0.21±0.14, with increased total costs of £603±909 to £2,240±1,124/patient, giving incremental cost-effectiveness ratios of £4,853 to £10,670/QALY gained, well within current UK willingness-to-pay limits. At a threshold of £30,000/QALY gained, there was a 78-85% probability that SMBG would be considered cost-effective. SMBG was most cost-effective in the subgroup of patients treated with diet and exercise. CONCLUSIONS: Improvements in glycemic control with interventions including SMBG improves patient outcomes with an acceptable cost-effectiveness ratio in the UK setting.