Clinical and Cost-Effectiveness of HbA1c Point-of-Care Devices for Glycemic Control: A Systematic Review and Meta-Analysis
Author(s)
Anjitha Krishna, MPH1, ANJANA BC, MPH1, Sandul Yasobant, Sr., PhD1, Divya Patil, PhD2, Edlin Mathias, PhD2, Elstin Anbu Raj, MPHARM3.
1Indian Institute of Public Health Gandhinagar, Gandhinagar, India, 2Centre for Evidence-informed Decision-making, Health Technology and informatics, PRASANNA SCHOOL OF PUBLIC HEALTH, MANIPAL ACADEMY OF HIGHER EDUCATION, MANIPAL, India, 3Centre for Evidence-informed Decision-making, PRASANNA SCHOOL OF PUBLIC HEALTH, MANIPAL ACADEMY OF HIGHER EDUCATION, MANIPAL, India.
1Indian Institute of Public Health Gandhinagar, Gandhinagar, India, 2Centre for Evidence-informed Decision-making, Health Technology and informatics, PRASANNA SCHOOL OF PUBLIC HEALTH, MANIPAL ACADEMY OF HIGHER EDUCATION, MANIPAL, India, 3Centre for Evidence-informed Decision-making, PRASANNA SCHOOL OF PUBLIC HEALTH, MANIPAL ACADEMY OF HIGHER EDUCATION, MANIPAL, India.
OBJECTIVES: The current systematic review aimed to assess the clinical effectiveness, cost-effectiveness, and patient/provider perspectives of HbA1c POC testing compared to standard laboratory-based testing.
METHODS: A comprehensive search was conducted across six databases—PubMed, Scopus, Web of Science, CINAHL, Embase, and Cochrane CENTRAL—for studies published between 2010 and 2025, following PRISMA guidelines. Eligible studies included both randomized and observational study designs that evaluated clinical outcomes, economic analyses, and user perspectives. Title/abstract and full-text screenings were independently performed using Rayyan software by two reviewers, with discrepancies resolved through consensus. Data were extracted, and the risk of bias was assessed using tools tailored to each study design. A narrative synthesis and meta-analysis were conducted based on extracted data.
RESULTS: A total of 18 studies were included, six of which were economic evaluations. Most studies reported a modest reduction in HbA1c levels with POC testing. A pooled meta-analysis of three studies showed a statistically significant mean HbA1c decrease of −0.21%, favoring POC testing. Two of the economic evaluations reported an incremental cost-effectiveness ratio (ICERs) of $40 and $1,947 per additional patient achieving glycemic control, which were below commonly accepted willingness-to-pay thresholds, indicating cost-effectiveness. Perspectives from both patients and providers reflected high acceptability and perceived practicality of POC testing.
CONCLUSIONS: POC HbA1c testing appears to offer both clinical and economic advantages, particularly in low-resource settings. While the evidence is promising, further long-term and implementation studies are needed to confirm the sustainability and broader applicability of these findings across diverse healthcare systems.
METHODS: A comprehensive search was conducted across six databases—PubMed, Scopus, Web of Science, CINAHL, Embase, and Cochrane CENTRAL—for studies published between 2010 and 2025, following PRISMA guidelines. Eligible studies included both randomized and observational study designs that evaluated clinical outcomes, economic analyses, and user perspectives. Title/abstract and full-text screenings were independently performed using Rayyan software by two reviewers, with discrepancies resolved through consensus. Data were extracted, and the risk of bias was assessed using tools tailored to each study design. A narrative synthesis and meta-analysis were conducted based on extracted data.
RESULTS: A total of 18 studies were included, six of which were economic evaluations. Most studies reported a modest reduction in HbA1c levels with POC testing. A pooled meta-analysis of three studies showed a statistically significant mean HbA1c decrease of −0.21%, favoring POC testing. Two of the economic evaluations reported an incremental cost-effectiveness ratio (ICERs) of $40 and $1,947 per additional patient achieving glycemic control, which were below commonly accepted willingness-to-pay thresholds, indicating cost-effectiveness. Perspectives from both patients and providers reflected high acceptability and perceived practicality of POC testing.
CONCLUSIONS: POC HbA1c testing appears to offer both clinical and economic advantages, particularly in low-resource settings. While the evidence is promising, further long-term and implementation studies are needed to confirm the sustainability and broader applicability of these findings across diverse healthcare systems.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE126
Topic
Clinical Outcomes, Economic Evaluation, Medical Technologies
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), No Additional Disease & Conditions/Specialized Treatment Areas