OBJECTIVES: Continuous glucose monitoring systems have been found to be beneficial in patients with type 1 diabetes (T1D), a chronic condition with complications such as hypoglycemia and ketoacidosis. Yet, further research is warranted to help improve clinical decision-making. In this study, we evaluated the cost-effectiveness of a real-time continuous glucose monitoring system (rt-CGM) compared to self-monitoring of blood glucose (SMBG) in older adults and adolescents with T1D.

METHODS: We used Microsoft Excel to calculate cost-effectiveness for three different diabetes states (controlled, hypoglycemic and hyperglycemic) in adults aged ≥60 and young adults aged 14-24 with T1D. We incorporated data on the diabetes monitoring system, emergency department visit costs, probability of the diabetes states, and utility of the diabetes states stratified by age for one year based on the most recent research available.

RESULTS: The mean total cost per patient was $10,536 for rt-CGM and $4,971 for SMBG, a difference of $5,565. Considering young adults only, the mean total cost per patient was $11,520 for rt-CGM and $4,629 for SMBG, a difference of $6,890. The improvement in effectiveness of rt-CGM over SMBG was 0.166 quality-adjusted life years (QALY). The incremental cost-effectiveness ratio (ICER) for T1D was $33,509 for older adults and $21,197 for young adults, considering the complications of hypoglycemia and hyperglycemia.

CONCLUSIONS: Rt-CGM is cost-effective compared to SMBG for older adults as well as young adults with T1D based on a willingness-to-pay threshold of $50,000/QALY. This benefit is more pronounced in young adult patients.