Cost–utility analysis of Dexcom G6 real-time continuous glucose monitoring versus FreeStyle Libre 1 intermittently scanned continuous glucose monitoring in adults with type 1 diabetes in Belgium
Aims/hypothesis The aim of this study was to assess the long-term cost-effectiveness of Dexcom G6 real-time continuous glucose monitoring (rtCGM) with alert functionality compared with FreeStyle Libre 1 intermittently scanned continuous glucose monitoring (isCGM) without alerts in adults with type 1...
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| Veröffentlicht in: | Diabetologia 2024-04, Vol.67 (4), p.650-662 |
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| creator | Visser, Margaretha M. Van Muylder, Astrid Charleer, Sara Isitt, John J. Roze, Stéphane De Block, Christophe Maes, Toon Vanhaverbeke, Gerd Nobels, Frank Keymeulen, Bart Mathieu, Chantal Luyten, Jeroen Gillard, Pieter Verhaeghe, Nick |
| description | Aims/hypothesis
The aim of this study was to assess the long-term cost-effectiveness of Dexcom G6 real-time continuous glucose monitoring (rtCGM) with alert functionality compared with FreeStyle Libre 1 intermittently scanned continuous glucose monitoring (isCGM) without alerts in adults with type 1 diabetes in Belgium.
Methods
The IQVIA CORE Diabetes Model was used to estimate cost-effectiveness. Input data for the simulated baseline cohort were sourced from the randomised ALERTT1 trial (ClinicalTrials.gov. registration no. NCT03772600). The age of the participants was 42.9 ± 14.1 years (mean ± SD), and the baseline HbA
1c
was 57.8 ± 9.5 mmol/mol (7.4 ± 0.9%). Participants using rtCGM showed a reduction in HbA
1c
of 3.6 mmol/mol (0.36 percentage points) based on the 6-month mean between-group difference. In the base case, both rtCGM and isCGM were priced at €3.92/day (excluding value-added tax [VAT]) according to the Belgian reimbursement system. The analysis was performed from a Belgian healthcare payer perspective over a lifetime time horizon. Health outcomes were expressed as quality-adjusted life years. Probabilistic and one-way sensitivity analyses were used to account for parameter uncertainty.
Results
In the base case, rtCGM dominated isCGM, resulting in lower diabetes-related complication costs and better health outcomes. The associated main drivers favouring rtCGM were lower HbA
1c
, fewer severe hypoglycaemic events and reduced fear of hypoglycaemia. The results were robust under a wide range of one-way sensitivity analyses. In models where the price of rtCGM is €5.11/day (a price increase of 30.4%) or €12.34/day (a price increase of 214.8%), rtCGM was cost-neutral or reached an incremental cost-effectiveness ratio of €40,000 per quality-adjusted life year, respectively.
Conclusions/interpretation
When priced similarly, Dexcom G6 rtCGM with alert functionality has both economic and clinical benefits compared with FreeStyle Libre 1 isCGM without alerts in adults with type 1 diabetes in Belgium, and appears to be a cost-effective glucose monitoring modality.
Trial registration
ClinicalTrials.gov NCT03772600
Graphical Abstract |
| doi_str_mv | 10.1007/s00125-023-06084-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2916407621</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2916407621</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-28391da468b398e445d25008486917a2819162ee12c0c00edacdfbfdd4cf012a3</originalsourceid><addsrcrecordid>eNqFkU-OFCEYxYnROO3oBVwYEjduSvnXNLXUdmY06cSFmrirUPBVy4SCFqjR2s0dvJIn8SRS9qiJC12xeL_3gPcQekjJU0rI5lkmhLJ1QxhviCRKNOwWWlHBWUMEU7fRatEbquSHE3Qv50tCCF8LeRedcMW4FKRdoW_bmMv3669Tcd6VGeug_ZxdxnHAL-GLiSO-kDiB9k1xI2ATQ3FhilPGez-ZmAGPMbgSkwt7fAUpV-U8Abwtswe8c30CTLELBdLoSoFQ_Iyz0SGA_U-aC1jbyZeMP7vyEZf5sERZp3sokBf5Bfi9m8b76M6gfYYHN-cpen9-9m77qtm9uXi9fb5rDGeyNEzxllotpOp5q0CItWVrUotTsqUbzRRtqWQAlBliCAGrjR36wVphhtqk5qfoyTH3kOKnCXLpRpcNeK8D1D90rPoF2UhGK_r4L_QyTqmWu1C8Pke2rawUO1ImxZwTDN0huVGnuaOkWzbujht3dePu58Ydq6ZHN9FTP4L9bfk1agX4EciHpUdIf-7-R-wPCGe3Aw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2933266996</pqid></control><display><type>article</type><title>Cost–utility analysis of Dexcom G6 real-time continuous glucose monitoring versus FreeStyle Libre 1 intermittently scanned continuous glucose monitoring in adults with type 1 diabetes in Belgium</title><source>SpringerLink Journals - AutoHoldings</source><creator>Visser, Margaretha M. ; Van Muylder, Astrid ; Charleer, Sara ; Isitt, John J. ; Roze, Stéphane ; De Block, Christophe ; Maes, Toon ; Vanhaverbeke, Gerd ; Nobels, Frank ; Keymeulen, Bart ; Mathieu, Chantal ; Luyten, Jeroen ; Gillard, Pieter ; Verhaeghe, Nick</creator><creatorcontrib>Visser, Margaretha M. ; Van Muylder, Astrid ; Charleer, Sara ; Isitt, John J. ; Roze, Stéphane ; De Block, Christophe ; Maes, Toon ; Vanhaverbeke, Gerd ; Nobels, Frank ; Keymeulen, Bart ; Mathieu, Chantal ; Luyten, Jeroen ; Gillard, Pieter ; Verhaeghe, Nick</creatorcontrib><description>Aims/hypothesis
The aim of this study was to assess the long-term cost-effectiveness of Dexcom G6 real-time continuous glucose monitoring (rtCGM) with alert functionality compared with FreeStyle Libre 1 intermittently scanned continuous glucose monitoring (isCGM) without alerts in adults with type 1 diabetes in Belgium.
Methods
The IQVIA CORE Diabetes Model was used to estimate cost-effectiveness. Input data for the simulated baseline cohort were sourced from the randomised ALERTT1 trial (ClinicalTrials.gov. registration no. NCT03772600). The age of the participants was 42.9 ± 14.1 years (mean ± SD), and the baseline HbA
1c
was 57.8 ± 9.5 mmol/mol (7.4 ± 0.9%). Participants using rtCGM showed a reduction in HbA
1c
of 3.6 mmol/mol (0.36 percentage points) based on the 6-month mean between-group difference. In the base case, both rtCGM and isCGM were priced at €3.92/day (excluding value-added tax [VAT]) according to the Belgian reimbursement system. The analysis was performed from a Belgian healthcare payer perspective over a lifetime time horizon. Health outcomes were expressed as quality-adjusted life years. Probabilistic and one-way sensitivity analyses were used to account for parameter uncertainty.
Results
In the base case, rtCGM dominated isCGM, resulting in lower diabetes-related complication costs and better health outcomes. The associated main drivers favouring rtCGM were lower HbA
1c
, fewer severe hypoglycaemic events and reduced fear of hypoglycaemia. The results were robust under a wide range of one-way sensitivity analyses. In models where the price of rtCGM is €5.11/day (a price increase of 30.4%) or €12.34/day (a price increase of 214.8%), rtCGM was cost-neutral or reached an incremental cost-effectiveness ratio of €40,000 per quality-adjusted life year, respectively.
Conclusions/interpretation
When priced similarly, Dexcom G6 rtCGM with alert functionality has both economic and clinical benefits compared with FreeStyle Libre 1 isCGM without alerts in adults with type 1 diabetes in Belgium, and appears to be a cost-effective glucose monitoring modality.
Trial registration
ClinicalTrials.gov NCT03772600
Graphical Abstract</description><identifier>ISSN: 0012-186X</identifier><identifier>EISSN: 1432-0428</identifier><identifier>DOI: 10.1007/s00125-023-06084-2</identifier><identifier>PMID: 38236409</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Cost analysis ; Diabetes ; Diabetes mellitus (insulin dependent) ; Glucose monitoring ; Human Physiology ; Hypoglycemia ; Internal Medicine ; Medicine ; Medicine & Public Health ; Metabolic Diseases ; Sensitivity analysis</subject><ispartof>Diabetologia, 2024-04, Vol.67 (4), p.650-662</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-28391da468b398e445d25008486917a2819162ee12c0c00edacdfbfdd4cf012a3</cites><orcidid>0000-0001-9111-4561 ; 0000-0003-0216-4028 ; 0000-0002-5387-6108 ; 0000-0001-9956-4970</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00125-023-06084-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00125-023-06084-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38236409$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Visser, Margaretha M.</creatorcontrib><creatorcontrib>Van Muylder, Astrid</creatorcontrib><creatorcontrib>Charleer, Sara</creatorcontrib><creatorcontrib>Isitt, John J.</creatorcontrib><creatorcontrib>Roze, Stéphane</creatorcontrib><creatorcontrib>De Block, Christophe</creatorcontrib><creatorcontrib>Maes, Toon</creatorcontrib><creatorcontrib>Vanhaverbeke, Gerd</creatorcontrib><creatorcontrib>Nobels, Frank</creatorcontrib><creatorcontrib>Keymeulen, Bart</creatorcontrib><creatorcontrib>Mathieu, Chantal</creatorcontrib><creatorcontrib>Luyten, Jeroen</creatorcontrib><creatorcontrib>Gillard, Pieter</creatorcontrib><creatorcontrib>Verhaeghe, Nick</creatorcontrib><title>Cost–utility analysis of Dexcom G6 real-time continuous glucose monitoring versus FreeStyle Libre 1 intermittently scanned continuous glucose monitoring in adults with type 1 diabetes in Belgium</title><title>Diabetologia</title><addtitle>Diabetologia</addtitle><addtitle>Diabetologia</addtitle><description>Aims/hypothesis
The aim of this study was to assess the long-term cost-effectiveness of Dexcom G6 real-time continuous glucose monitoring (rtCGM) with alert functionality compared with FreeStyle Libre 1 intermittently scanned continuous glucose monitoring (isCGM) without alerts in adults with type 1 diabetes in Belgium.
Methods
The IQVIA CORE Diabetes Model was used to estimate cost-effectiveness. Input data for the simulated baseline cohort were sourced from the randomised ALERTT1 trial (ClinicalTrials.gov. registration no. NCT03772600). The age of the participants was 42.9 ± 14.1 years (mean ± SD), and the baseline HbA
1c
was 57.8 ± 9.5 mmol/mol (7.4 ± 0.9%). Participants using rtCGM showed a reduction in HbA
1c
of 3.6 mmol/mol (0.36 percentage points) based on the 6-month mean between-group difference. In the base case, both rtCGM and isCGM were priced at €3.92/day (excluding value-added tax [VAT]) according to the Belgian reimbursement system. The analysis was performed from a Belgian healthcare payer perspective over a lifetime time horizon. Health outcomes were expressed as quality-adjusted life years. Probabilistic and one-way sensitivity analyses were used to account for parameter uncertainty.
Results
In the base case, rtCGM dominated isCGM, resulting in lower diabetes-related complication costs and better health outcomes. The associated main drivers favouring rtCGM were lower HbA
1c
, fewer severe hypoglycaemic events and reduced fear of hypoglycaemia. The results were robust under a wide range of one-way sensitivity analyses. In models where the price of rtCGM is €5.11/day (a price increase of 30.4%) or €12.34/day (a price increase of 214.8%), rtCGM was cost-neutral or reached an incremental cost-effectiveness ratio of €40,000 per quality-adjusted life year, respectively.
Conclusions/interpretation
When priced similarly, Dexcom G6 rtCGM with alert functionality has both economic and clinical benefits compared with FreeStyle Libre 1 isCGM without alerts in adults with type 1 diabetes in Belgium, and appears to be a cost-effective glucose monitoring modality.
Trial registration
ClinicalTrials.gov NCT03772600
Graphical Abstract</description><subject>Cost analysis</subject><subject>Diabetes</subject><subject>Diabetes mellitus (insulin dependent)</subject><subject>Glucose monitoring</subject><subject>Human Physiology</subject><subject>Hypoglycemia</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic Diseases</subject><subject>Sensitivity analysis</subject><issn>0012-186X</issn><issn>1432-0428</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNqFkU-OFCEYxYnROO3oBVwYEjduSvnXNLXUdmY06cSFmrirUPBVy4SCFqjR2s0dvJIn8SRS9qiJC12xeL_3gPcQekjJU0rI5lkmhLJ1QxhviCRKNOwWWlHBWUMEU7fRatEbquSHE3Qv50tCCF8LeRedcMW4FKRdoW_bmMv3669Tcd6VGeug_ZxdxnHAL-GLiSO-kDiB9k1xI2ATQ3FhilPGez-ZmAGPMbgSkwt7fAUpV-U8Abwtswe8c30CTLELBdLoSoFQ_Iyz0SGA_U-aC1jbyZeMP7vyEZf5sERZp3sokBf5Bfi9m8b76M6gfYYHN-cpen9-9m77qtm9uXi9fb5rDGeyNEzxllotpOp5q0CItWVrUotTsqUbzRRtqWQAlBliCAGrjR36wVphhtqk5qfoyTH3kOKnCXLpRpcNeK8D1D90rPoF2UhGK_r4L_QyTqmWu1C8Pke2rawUO1ImxZwTDN0huVGnuaOkWzbujht3dePu58Ydq6ZHN9FTP4L9bfk1agX4EciHpUdIf-7-R-wPCGe3Aw</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Visser, Margaretha M.</creator><creator>Van Muylder, Astrid</creator><creator>Charleer, Sara</creator><creator>Isitt, John J.</creator><creator>Roze, Stéphane</creator><creator>De Block, Christophe</creator><creator>Maes, Toon</creator><creator>Vanhaverbeke, Gerd</creator><creator>Nobels, Frank</creator><creator>Keymeulen, Bart</creator><creator>Mathieu, Chantal</creator><creator>Luyten, Jeroen</creator><creator>Gillard, Pieter</creator><creator>Verhaeghe, Nick</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9111-4561</orcidid><orcidid>https://orcid.org/0000-0003-0216-4028</orcidid><orcidid>https://orcid.org/0000-0002-5387-6108</orcidid><orcidid>https://orcid.org/0000-0001-9956-4970</orcidid></search><sort><creationdate>20240401</creationdate><title>Cost–utility analysis of Dexcom G6 real-time continuous glucose monitoring versus FreeStyle Libre 1 intermittently scanned continuous glucose monitoring in adults with type 1 diabetes in Belgium</title><author>Visser, Margaretha M. ; Van Muylder, Astrid ; Charleer, Sara ; Isitt, John J. ; Roze, Stéphane ; De Block, Christophe ; Maes, Toon ; Vanhaverbeke, Gerd ; Nobels, Frank ; Keymeulen, Bart ; Mathieu, Chantal ; Luyten, Jeroen ; Gillard, Pieter ; Verhaeghe, Nick</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-28391da468b398e445d25008486917a2819162ee12c0c00edacdfbfdd4cf012a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Cost analysis</topic><topic>Diabetes</topic><topic>Diabetes mellitus (insulin dependent)</topic><topic>Glucose monitoring</topic><topic>Human Physiology</topic><topic>Hypoglycemia</topic><topic>Internal Medicine</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic Diseases</topic><topic>Sensitivity analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Visser, Margaretha M.</creatorcontrib><creatorcontrib>Van Muylder, Astrid</creatorcontrib><creatorcontrib>Charleer, Sara</creatorcontrib><creatorcontrib>Isitt, John J.</creatorcontrib><creatorcontrib>Roze, Stéphane</creatorcontrib><creatorcontrib>De Block, Christophe</creatorcontrib><creatorcontrib>Maes, Toon</creatorcontrib><creatorcontrib>Vanhaverbeke, Gerd</creatorcontrib><creatorcontrib>Nobels, Frank</creatorcontrib><creatorcontrib>Keymeulen, Bart</creatorcontrib><creatorcontrib>Mathieu, Chantal</creatorcontrib><creatorcontrib>Luyten, Jeroen</creatorcontrib><creatorcontrib>Gillard, Pieter</creatorcontrib><creatorcontrib>Verhaeghe, Nick</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetologia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Visser, Margaretha M.</au><au>Van Muylder, Astrid</au><au>Charleer, Sara</au><au>Isitt, John J.</au><au>Roze, Stéphane</au><au>De Block, Christophe</au><au>Maes, Toon</au><au>Vanhaverbeke, Gerd</au><au>Nobels, Frank</au><au>Keymeulen, Bart</au><au>Mathieu, Chantal</au><au>Luyten, Jeroen</au><au>Gillard, Pieter</au><au>Verhaeghe, Nick</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost–utility analysis of Dexcom G6 real-time continuous glucose monitoring versus FreeStyle Libre 1 intermittently scanned continuous glucose monitoring in adults with type 1 diabetes in Belgium</atitle><jtitle>Diabetologia</jtitle><stitle>Diabetologia</stitle><addtitle>Diabetologia</addtitle><date>2024-04-01</date><risdate>2024</risdate><volume>67</volume><issue>4</issue><spage>650</spage><epage>662</epage><pages>650-662</pages><issn>0012-186X</issn><eissn>1432-0428</eissn><abstract>Aims/hypothesis
The aim of this study was to assess the long-term cost-effectiveness of Dexcom G6 real-time continuous glucose monitoring (rtCGM) with alert functionality compared with FreeStyle Libre 1 intermittently scanned continuous glucose monitoring (isCGM) without alerts in adults with type 1 diabetes in Belgium.
Methods
The IQVIA CORE Diabetes Model was used to estimate cost-effectiveness. Input data for the simulated baseline cohort were sourced from the randomised ALERTT1 trial (ClinicalTrials.gov. registration no. NCT03772600). The age of the participants was 42.9 ± 14.1 years (mean ± SD), and the baseline HbA
1c
was 57.8 ± 9.5 mmol/mol (7.4 ± 0.9%). Participants using rtCGM showed a reduction in HbA
1c
of 3.6 mmol/mol (0.36 percentage points) based on the 6-month mean between-group difference. In the base case, both rtCGM and isCGM were priced at €3.92/day (excluding value-added tax [VAT]) according to the Belgian reimbursement system. The analysis was performed from a Belgian healthcare payer perspective over a lifetime time horizon. Health outcomes were expressed as quality-adjusted life years. Probabilistic and one-way sensitivity analyses were used to account for parameter uncertainty.
Results
In the base case, rtCGM dominated isCGM, resulting in lower diabetes-related complication costs and better health outcomes. The associated main drivers favouring rtCGM were lower HbA
1c
, fewer severe hypoglycaemic events and reduced fear of hypoglycaemia. The results were robust under a wide range of one-way sensitivity analyses. In models where the price of rtCGM is €5.11/day (a price increase of 30.4%) or €12.34/day (a price increase of 214.8%), rtCGM was cost-neutral or reached an incremental cost-effectiveness ratio of €40,000 per quality-adjusted life year, respectively.
Conclusions/interpretation
When priced similarly, Dexcom G6 rtCGM with alert functionality has both economic and clinical benefits compared with FreeStyle Libre 1 isCGM without alerts in adults with type 1 diabetes in Belgium, and appears to be a cost-effective glucose monitoring modality.
Trial registration
ClinicalTrials.gov NCT03772600
Graphical Abstract</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>38236409</pmid><doi>10.1007/s00125-023-06084-2</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0001-9111-4561</orcidid><orcidid>https://orcid.org/0000-0003-0216-4028</orcidid><orcidid>https://orcid.org/0000-0002-5387-6108</orcidid><orcidid>https://orcid.org/0000-0001-9956-4970</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0012-186X |
| ispartof | Diabetologia, 2024-04, Vol.67 (4), p.650-662 |
| issn | 0012-186X 1432-0428 |
| language | eng |
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| source | SpringerLink Journals - AutoHoldings |
| subjects | Cost analysis Diabetes Diabetes mellitus (insulin dependent) Glucose monitoring Human Physiology Hypoglycemia Internal Medicine Medicine Medicine & Public Health Metabolic Diseases Sensitivity analysis |
| title | Cost–utility analysis of Dexcom G6 real-time continuous glucose monitoring versus FreeStyle Libre 1 intermittently scanned continuous glucose monitoring in adults with type 1 diabetes in Belgium |
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