Cost-effectiveness of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin.
BACKGROUND
The benefits of self-monitoring blood glucose levels are unclear in patients with type 2 diabetes mellitus who do not use insulin, but there are considerable costs. We sought to determine the cost effectiveness of self-monitoring for patients with type 2 diabetes not using insulin.


METHODS
We performed an incremental cost-effectiveness analysis of the self-monitoring of blood glucose in adults with type 2 diabetes not taking insulin. We used the United Kingdom Prospective Diabetes Study (UKPDS) model to forecast diabetes-related complications, corresponding quality-adjusted life years and costs. Clinical data were obtained from a systematic review comparing self-monitoring with no self-monitoring. Costs and utility decrements were derived from published sources. We performed sensitivity analyses to examine the robustness of the results.


RESULTS
Based on a clinically modest reduction in hemoglobin A(1C) of 0.25% (95% confidence interval 0.15-0.36) estimated from the systematic review, the UKPDS model predicted that self-monitoring performed 7 or more times per week reduced the lifetime incidence of diabetes-related complications compared with no self-monitoring, albeit at a higher cost (incremental cost per quality-adjusted life year $113,643). The results were largely unchanged in the sensitivity analysis, although the incremental cost per quality-adjusted life year fell within widely cited cost-effectiveness thresholds when testing frequency or the price per test strip was substantially reduced from the current levels.


CONCLUSIONS
For most patients with type 2 diabetes not using insulin, use of blood glucose test strips for frequent self-monitoring (>or= 7 times per week) is unlikely to represent efficient use of finite health care resources, although periodic testing (e.g., 1 or 2 times per week) may be cost-effective. Reduced test strip price would likely also improve cost-effectiveness.
Cameron
Chris
C
Canadian Optimal Medication Prescribing and Utilization Service (COMPUS), Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Ont. chrisc@cadth.ca
Coyle
Doug
D
Ur
Ehud
E
Klarenbach
Scott
S
D000328:Adult; D015190:Blood Glucose Self-Monitoring / Q000191:economics*; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000191:economics* / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D011446:Prospective Studies; D006113:United Kingdom
D007004:Hypoglycemic Agents