ECONOMIC EVALUATION OF CONTINUOUSGLUCOSE MONITORING DEVICES VERSUS SMBG FOR TYPE 1 DIABETIC CHILDREN IN EGYPT FROM A SOCIETAL PERSPECTIVE
Author(s)
MOHAMED SEOUDI, MSc1, Nancy Samir Elbarbary, MD2, MONA HANA, MD3, Shereen Abdelghaffar, MD4, Ahmed El Sabawy, MD5, Ahmed Khalil, BSc1, Marwa Kamal, MSc1, Galal ElShishiney, MSc1, Sameh Tawfik, MD6, Randa Nofa, MD3, Yasmin Mosallam, MSc3, Sondos Shawky, MSc3, Mona Salem, MD7, Mohamed Hesham Elhefnawy, MD5, Mohamed Hassany, MD1.
1Ministry of Health and Population, Cairo, Egypt, 2Diabetes and Endocrine Unit, Department of Pediatrics, Faculty of medicine, Ain shams University, Cairo, Egypt, 3Health Insurance Organization, Cairo, Egypt, 4Pediatric Diabetes and Endocrinology, Cairo University, Cairo, Egypt, 5National institute of Diabetes and endocrinology, Cairo, Egypt, 6Military Medical Academy, Cairo, Egypt, 7Pediatric Department, Ain Shams University, Cairo, Egypt.
1Ministry of Health and Population, Cairo, Egypt, 2Diabetes and Endocrine Unit, Department of Pediatrics, Faculty of medicine, Ain shams University, Cairo, Egypt, 3Health Insurance Organization, Cairo, Egypt, 4Pediatric Diabetes and Endocrinology, Cairo University, Cairo, Egypt, 5National institute of Diabetes and endocrinology, Cairo, Egypt, 6Military Medical Academy, Cairo, Egypt, 7Pediatric Department, Ain Shams University, Cairo, Egypt.
OBJECTIVES: Evidence on the economic value of continuous glucose monitoring (CGM) in children with Type 1 Diabetes Mellitus (T1DM) is limited in low- and middle-income countries. This study evaluated the cost-effectiveness of CGM compared with self-monitoring of blood glucose (SMBG) in Egyptian children and adolescents with T1DM from a societal perspective.
METHODS: A lifetime Markov cohort model was developed in R to compare CGM and SMBG in children and adolescences aged 4-17 years with T1DM receiving multiple daily injections. Four health states (controlled glycemia, severe hypoglycemia, diabetic ketoacidosis [DKA], and all-cause mortality) were modeled. Clinical outcomes, utilities, complication rates, and costs were obtained from published evidence and a high-risk tertiary pediatric diabetes cohort from Atfal Misr Hospital, Cairo. Direct medical and indirect societal costs were included and discounted at 3% annually. Model uncertainty was assessed through deterministic and probabilistic sensitivity analyses.
RESULTS: CGM was economically dominant over SMBG, yielding an incremental gain of 34.04 quality-adjusted life years (QALYs) and lifetime cost savings of EGP 1,486,133 per patient. Mortality was lower in the CGM arm, reflecting reductions in acute diabetes-related complications. Cost offsets were primarily driven by substantial reductions in severe hypoglycemia (4.9 vs 0.026 events/year) and diabetic ketoacidosis (DKA) hospitalizations (2.9 vs 0.2 episodes/year). In a cohort of 1,000 patients, CGM generated annual societal savings of EGP 106.1 million and a return on investment of 308%. Probabilistic sensitivity analysis confirmed cost-saving status in 95% of simulations. One-way sensitivity analysis identified severe hypoglycemia rates and baseline utility values as the principal drivers of model uncertainty.
CONCLUSIONS: CGM provides substantial health gains while reducing overall societal costs compared with SMBG in Egyptian T1DM children. Remaining cost-saving across sensitivity analyses, CGM demonstrates economic dominance and offers strong evidence to support reimbursement and wider adoption within national healthcare programs, particularly for high-risk pediatric populations.
METHODS: A lifetime Markov cohort model was developed in R to compare CGM and SMBG in children and adolescences aged 4-17 years with T1DM receiving multiple daily injections. Four health states (controlled glycemia, severe hypoglycemia, diabetic ketoacidosis [DKA], and all-cause mortality) were modeled. Clinical outcomes, utilities, complication rates, and costs were obtained from published evidence and a high-risk tertiary pediatric diabetes cohort from Atfal Misr Hospital, Cairo. Direct medical and indirect societal costs were included and discounted at 3% annually. Model uncertainty was assessed through deterministic and probabilistic sensitivity analyses.
RESULTS: CGM was economically dominant over SMBG, yielding an incremental gain of 34.04 quality-adjusted life years (QALYs) and lifetime cost savings of EGP 1,486,133 per patient. Mortality was lower in the CGM arm, reflecting reductions in acute diabetes-related complications. Cost offsets were primarily driven by substantial reductions in severe hypoglycemia (4.9 vs 0.026 events/year) and diabetic ketoacidosis (DKA) hospitalizations (2.9 vs 0.2 episodes/year). In a cohort of 1,000 patients, CGM generated annual societal savings of EGP 106.1 million and a return on investment of 308%. Probabilistic sensitivity analysis confirmed cost-saving status in 95% of simulations. One-way sensitivity analysis identified severe hypoglycemia rates and baseline utility values as the principal drivers of model uncertainty.
CONCLUSIONS: CGM provides substantial health gains while reducing overall societal costs compared with SMBG in Egyptian T1DM children. Remaining cost-saving across sensitivity analyses, CGM demonstrates economic dominance and offers strong evidence to support reimbursement and wider adoption within national healthcare programs, particularly for high-risk pediatric populations.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE21
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Work & Home Productivity - Indirect Costs
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), No Additional Disease & Conditions/Specialized Treatment Areas, Pediatrics