title: Health-economic analysis of real-time continuous glucose monitoring in people with Type 1 diabetes.
abstract: OBJECTIVE
  To evaluate the clinical benefits and cost-effectiveness of the sensor-augmented pump compared with self-monitoring of plasma glucose plus continuous subcutaneous insulin infusion in people with Type 1 diabetes.
  
  
  METHODS
  The CORE Diabetes Model was used to simulate disease progression in a cohort of people with baseline characteristics taken from a published meta-analysis. Direct and indirect costs for 2010-2011 were calculated from a societal payer perspective, with cost-effectiveness calculated over the patient's lifetime. Discount rates of 3% per annum were applied to the costs and the clinical outcomes.
  
  
  RESULTS
  Use of the sensor-augmented pump was associated with an increase in mean discounted, quality-adjusted life expectancy of 0.76 quality-adjusted life years compared with continuous subcutaneous insulin infusion (13.05 ± 0.12 quality-adjusted life years vs 12.29 ± 0.12 quality-adjusted life years, respectively). Undiscounted life expectancy increased by 1.03 years for the sensor-augmented pump compared with continuous subcutaneous insulin infusion. In addition, the onset of complications was delayed (by a mean of 1.15 years) with use of the sensor-augmented pump. This analysis resulted in an incremental cost-effectiveness ratio of 367,571 SEK per quality-adjusted life year gained with the sensor-augmented pump. The additional treatment costs related to the use of the sensor-augmented pump were partially offset by the savings attributable to the reduction in diabetes-related complications and the lower frequency of self-monitoring of plasma glucose.
  
  
  CONCLUSIONS
  Analysis using the CORE Diabetes Model showed that improvements in glycaemic control associated with sensor-augmented pump use led to a reduced incidence of diabetes-related complications and a longer life expectancy. Use of the sensor-augmented pump was associated with an incremental cost-effectiveness ratio of 367,571 SEK per quality-adjusted life year gained, which is likely to represent good value for money in the treatment of Type 1 diabetes in Sweden.
authors.affiliation: HEVA HEOR, Lyon, France.
authors.forename: S
authors.initials: S
authors.lastname: Roze
authors.forename: R
authors.initials: R
authors.lastname: Saunders
authors.forename: A-S
authors.initials: AS
authors.lastname: Brandt
authors.forename: S
authors.initials: S
authors.lastname: de Portu
authors.forename: N L
authors.initials: NL
authors.lastname: Papo
authors.forename: J
authors.initials: J
authors.lastname: Jendle
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring / Q000191:economics*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use*; D007332:Insulin Infusion Systems / Q000191:economics*; D008297:Male; D008954:Models, Biological; D008991:Monitoring, Physiologic / Q000191:economics / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin