OBJECTIVES: Randomized controlled trials have shown the effectiveness of rtCGM in improving glycemic control and reducing risk of severe hypoglycemia in patients with type 1 diabetes (T1D). We aim to study the cost-effectiveness of rtCGM for T1D patients in the Netherlands.

METHODS: The analysis was conducted using the IQVIA Core Diabetes Model. Clinical efficacy data was extracted from the DIAMOND trial of adults with T1D on multiple daily injections of insulin. The baseline mean age (SD) of the cohort was 47.6 years (12.7) and proportion of female 56%. Mean baseline HbA1c for the cohort was 8.6% (70 mmol/mol). HbA1c reduction was -1.0 and -0.4 for rtCGM and SMBG, respectively. An additional utility benefit of 0.03 for avoidance of finger sticks was assigned to rtCGM patients. Annual costs of Dexcom G6 rtCGM of €2,912 was used vs €503.7 for SMBG. Direct medical costs were sourced from the published literature and inflated to 2021. The analysis was conducted from the Netherlands payer perspective over a lifetime horizon.

RESULTS: RtCGM was associated with a 2.12 incremental gain in quality-adjusted life years (QALYs) compared with SMBG (mean±SD 15.67±3.37 versus 13.54±3.0 QALYs). The total direct costs were €128,846 and €102,402 for rtCGM and SMBG, respectively. The incremental cost-effectiveness ratio (ICER) was €12,470/QALY. The likelihood of rtCGM being cost-effective under €30,000 willingness to pay threshold (WTP) was 99.9%. Main drivers of cost-effectiveness of rtCGM identified include HbA1c reduction, utility for avoidance of finger sticks, and costs of rtCGM. RtCGM remained cost-effective under €30,000 WTP even after reducing HbA1c effect by 30% (ICER:15,938), decreasing utility by 50% (ICER: 18,280), and increasing its cost by 50% (ICER: 19,310).

CONCLUSIONS: Our analysis shows that rtCGM is cost-effective in patients with T1D in the Netherlands. This study provides payors and policy makers with economic evidence to widen access to rtCGM.