OBJECTIVES: Studies have shown the value of continuous glucose monitoring (CGM) systems in the treatment of patients with T2 diabetes on insulin. However, no studies are available directly comparing real-time CGM with Flash CGM (rt-CGM and FGM, respectively). The objective of this research is to compare the cost of the new Dexcom ONE rt-CGM and the currently used Free Style Libre 2 (FSL2) FGM in the diabetes type 2 population on an intensive insulin schedule from the perspective of the Italian healthcare payer.

METHODS: A budget impact model was developed to estimate the cost difference between Dexcom ONE and FSL2 through an indirect comparison via self-monitoring of blood glucose (SMBG). Clinical data on HbA1c reduction and reductions in acute hospitalisations for severe hypoglycemic events and diabetes ketoacidosis with Dexcom ONE and FGM versus SMBG, were derived from a targeted review of available literature. Both RCT and real-world data were included. Baseline rates for acute hospitalisations were drawn from epidemiological literature on Italy. Healthcare costs including cost of strips, sensors and acute hospitalisations were also derived from Italian sources. One-way sensitivity analysis varying HbA1c reduction, acute hospitalization rates and costs were performed to investigate the robustness of the analysis.

RESULTS: From the perspective of the Italian healthcare payer, the cost for the acquisition of Dexcom ONE (EUR 332 per patient per year) was offset by savings in HbA1c-related costs, such as hospitalizations, doctor visits and additional medication use (EUR 529 per patient per year). This resulted in net savings of EUR 197 per patient per year with Dexcom ONE compared to FSL2. The one-way sensitivity analysis showed the robustness of the results in favor of Dexcom ONE.

CONCLUSIONS: Dexcom ONE is a potential cost saving strategy for the treatment of patients with T2 diabetes on an intensive insulin schedule in Italy.