OBJECTIVES: Type 1 diabetes mellitus (T1DM) is a chronic disease with the potential for significant complications. Despite the availability of exogenous insulin to treat T1DM, a large percentage of patients do not maintain adequate glycemic control, which can lead to hypoglycemia or ketoacidosis. Our objective was to determine the cost-effectiveness of real-time continuous glucose monitoring (RT-CGM) compared to non-continuous or self-monitoring (NCGM) in patients with T1DM in the United States.

METHODS: Using data from recently published randomized controlled trials and meta-analyses, we populated a decision analysis tree considering RT-CGM and NCGM with three main outcomes: controlled glycemic status, hyperglycemia, and hypoglycemia. The data used to populate the tree included probabilities of the outcomes, the costs associated with the utilization of each technology, the cost of complication outcomes, and the cost of typical treatment of T1DM. All analyses were conducted using Microsoft Excel.

RESULTS: Data included in our analysis showed that hypoglycemia occurred in 5% of patients using RT-CGM, compared to 8% using NCGM, and that 94% of patients using RT-CGM achieved optimal control of their disease, compared to 90% using NCGM. The occurrence of hyperglycemia was similar in both groups. Considering these outcomes and costs, RT-CGM resulted in an expected improvement in effectiveness of 0.05 QALYs and an increase in cost of $1,620 resulting in an ICER of $32,400/QALY. The robustness of our findings was confirmed through sensitivity analysis.

CONCLUSIONS: RT-CGM can be considered a high value technology compared to NCGM because it improved glucose control and reduced the occurrence of hypoglycemia. Considering a willingness-to-pay threshold of $50,000/QALY, RT-CGM is cost-effective for the control of T1DM.