Nationally Subsidized Continuous Glucose Monitoring: A Cost-effectiveness Analysis

Anthony J Pease, Sophia Zoungas, Emily Callander, Timothy W Jones, Stephanie R Johnson, D Jane Holmes-Walker, David E Bloom, Elizabeth A Davis, Ella Zomer

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

OBJECTIVE: The Continuous Glucose Monitoring (CGM) Initiative recently introduced universal subsidized CGM funding for people with type 1 diabetes under 21 years of age in Australia. We thus aimed to evaluate the cost-effectiveness of this CGM Initiative based on national implementation data and project the economic impact of extending the subsidy to all age-groups.

RESEARCH DESIGN AND METHODS: We used a patient-level Markov model to simulate disease progression for young people with type 1 diabetes and compared government-subsidized access to CGM with the previous user-funded system. Three years of real-world clinical input data were sourced from analysis of the Australasian Diabetes Data Network and National Diabetes Services Scheme registries. Costs were considered from the Australian health care system's perspective. An annual discount rate of 5% was applied to future costs and outcomes. Uncertainty was evaluated with probabilistic and deterministic sensitivity analyses.

RESULTS: Government-subsidized CGM funding for young people with type 1 diabetes compared with a completely user-funded model resulted in an incremental cost-effectiveness ratio (ICER) of AUD 39,518 per quality-adjusted life-year (QALY) gained. Most simulations (85%) were below the commonly accepted willingness-to-pay threshold of AUD 50,000 per QALY gained in Australia. Sensitivity analyses indicated that base-case results were robust, though strongly impacted by the cost of CGM devices. Extending the CGM Initiative throughout adulthood resulted in an ICER of AUD 34,890 per QALY gained.

CONCLUSIONS: Providing subsidized access to CGM for people with type 1 diabetes was found to be cost-effective compared with a completely user-funded model in Australia.

ARTICLE HIGHLIGHTS: Identifying efficient funding models for CGM is of international importance. From an economic perspective, we evaluated the Australian government's recent CGM Initiative, which has provided subsidized access to CGM for people with type 1 diabetes under 21 years of age. Using real-world clinical input data in a Markov model, we found that subsidized access to CGM for people with type 1 diabetes across the life span was cost-effective compared with user-funded CGM. Our findings support ongoing subsidization of CGM among youth and extending eligibility to people with type 1 diabetes of all ages.

Original languageEnglish
Article numberdc220951
Pages (from-to)2611-2619
Number of pages9
JournalDiabetes Care
Volume45
Issue number11
DOIs
Publication statusPublished - Nov 2022

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