Self-monitoring of blood glucose in type 2 diabetes: cost-effectiveness in the united states.
OBJECTIVE
This study was designed to model the cost-effectiveness of self-monitoring of blood glucose (SMBG) at frequencies of 1 or 3 times per day for patients with type 2 diabetes mellitus (T2DM) who are treated with oral antidiabetic (OAD) medications within the United States.


METHODS
Based on a Kaiser Permanente study showing glycosylated hemoglobin (HbA1C) improvements related to SMBG frequency, a validated model was used to project 40-year clinical and economic outcomes for SMBG at 1 or 3 times per day vs no SMBG.


METHODS
Baseline mean HbA1C (8.6%), age, and sex of the simulated cohort came from the Kaiser analysis of new SMBG users of OAD agents for T2DM. Other cohort characteristics, transition probabilities, utilities, and direct costs (from a US public payer perspective) were derived from relevant literature. Outcomes were discounted at 3% per annum, with sensitivity analyses performed on discount rates and time horizons.


RESULTS
Compared with no SMBG, quality-adjusted life expectancy increased with SMBG frequency. Increases were 0.103 and 0.327 quality-adjusted life-years (QALYs) for SMBG at 1 and 3 times per day, respectively. Corresponding incremental cost-effective ratios (ICERs) were $7856 and $6601 per QALY gained. Results indicate that SMBG at both 1 and 3 times per day in this cohort of patients with T2DM taking OADs would represent good value for money in the United States, with ICERs being most sensitive to the time horizon.


CONCLUSIONS
Longer time horizons generally led to greater SMBG cost-effectiveness. The ICER for SMBG 3 times per day was $518 per QALY over a 10-year time horizon, indicating very good value.
Tunis
Sandra L
SL
Dvision of Health Economics and Outcomes Research, IMS Consulting Services, 14701 Cumberland Rd, Ste 107, Noblesville, IN 46060, USA. stunis@us.imshealth.com
Minshall
Michael E
ME
D015190:Blood Glucose Self-Monitoring / Q000191:economics / Q000706:statistics & numerical data*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000191:economics* / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy / Q000191:economics; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D014481:United States / Q000453:epidemiology
D006442:Glycated Hemoglobin