OBJECTIVES : The use of real time continuous glucose monitoring (rt-CGM) can help patients with diabetes better manage their glucose levels and avoid acute complications, such as hypoglycemia. The aim of this evaluation is to assess health-related utility (U) from reduced fear of hypoglycemia (FoH) and the impact on the ICER resulting from comparing rt-CGM with self-monitoring of blood glucose (SMBG).

METHODS : IQVIA CORE Diabetes Model v.9.0 was used to assess cost-effectiveness. Patient characteristics were based on the DIaMonD Study (Beck, 2017) and clinical outcomes were extracted from Billings et al 2018, that separately examines DiaMonD Study patients with non-controlled diabetes (HbA1c > 8.5%). Patient-reported FoH was collected using the worry sub-scale of the revised 18-item HFS-II questionnaire. The FoH scale was converted to the EQ-5D index scale based on Currie et al 2006. Diabetes costs were derived from Spanish sources and published literature. Base case analysis only included U gains due to reduced hypoglycemia rates. 10 additional sensitivity analyses were conducted to assess the impact of increasing patients’ U due to FoH.

RESULTS : Base case ICER for rt-CGM vs. SMBG was 26,847€/QALY. When introducing the assumption of increased U gain due to reduced FoH, the analysis showed a linear increase of 12.2% in the incremental QALY gain per every 0.01 increase in U with a corresponding decrease in ICER When applying conservative U gains due to decreased FoH (ranging from 0.02 to 0.05) the ICER ranges from 21,587 to 16,685 €/QALY.

CONCLUSIONS : Using rt-CGM was associated with improved clinical outcomes and decreased FoH. Inclusion of FoH may be an important determinant of health-related utility in cost-effectiveness analyses of rt-CGM vs SMBG. Health-utility scores derived from FoH in this study may be useful in demonstrating the added treatment benefit of rt-CGM in economic evaluations of rt-CGM in diabetes patients