Cost-Utility Analysis of Flash Glucose Monitoring Systems in People With Type 2 Diabetes Mellitus and Poor Glycemic Control on Basal Insulin From the Spanish Health System Perspective

Speaker(s)

Oyagüez I1, Bellido Castañeda V2, Ampudia-Blasco FJ3, Carretero Gómez J4, Cebrián Cuenca AM5, Gómez-Peralta F6, Hernández Martínez AM7, Mezquita P8
1Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, M, Spain, 2Virgen del Rocío University Hospital, Sevilla, Andalucía, Spain, 3Clinic University Hospital Valencia, Valencia, Comunidad Valenciana, Spain, 4Badajoz University Hospital, Badajoz, Extremadura, Spain, 5Health Center Cartagena Casco, Cartagena, Murcia, Spain, 6Endocrinology and Nutrition Unit, Segovia General Hospital, Segovia, Castilla y León, Spain, 7Virgen de la Arrixaca University Hospital, Murcia, Murcia, Spain, 8Torrecárdenas University Hospital, Almería, Andalucía, Spain

OBJECTIVES: To assess the cost-utility of FreeStyle Libre systems (FSL) vs self-blood glucose monitoring (SMBG) in patients with Type 2 Diabetes Mellitus (T2DM) and poor glycemic control receiving basal insulin from the Spanish Health System perspective.

METHODS: The validated DEDUCE microsimulation model was used to estimate lifetime total direct costs (€,2024) and health outcomes in terms of quality-adjusted life years (QALYs), in a hypothetical cohort of 10,000 T2DM patients receiving basal insulin with poor glycemic control (mean HbA1c=9.2%). Baseline patient’s characteristics such as mean age (62.9 years), SBP (139 mmHg), total cholesterol (201.8 mg/dL) and incidence of mild and severe hypoglycemia (17.02 and 2.5 person-years event respectively) as well as diabetic ketoacidosis (2.5 events per 1000 person-years), were obtained from published literature. The Spanish National Health system perspective was applied. SBMG implied 2.5 strip/lancet/day (€0.55/strip and €0.14/lancet), while the use of the FSL (26 sensors-year and 0.43 strip/lancet/day) was associated to HbA1c reduction (-1.1%) based on published real-world evidence. Diabetic complications were estimated by risk equations (RECODe) according to baseline characteristics and HbA1c levels. Unitary costs for acute events and diabetic complications derived also from public costs sources or literature. Utility values reported on a regional health technology assessment analysis of glucose monitoring were used. All inputs were validated by local clinical experts. Sensitivity analyses were performed.

RESULTS: FSL yielded 0.8002 additional QALY and lower total costs (€-14,796 costs) in comparison to SBGM, resulting in a dominant strategy. In a probabilistic sensitivity analyses FSL remain cost-effective vs SBGM in 100% of the 1,000 iterations.

CONCLUSIONS: FSL would be a more effective alternative, providing cost-savings for the Spanish Healthcare system in T2DM population on basal insulin and poorly controlled.

Code

EE418

Topic

Economic Evaluation, Medical Technologies

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis, Medical Devices

Disease

Diabetes/Endocrine/Metabolic Disorders (including obesity), Medical Devices