title: The Cost-Effectiveness of Real-Time Continuous Glucose Monitoring (RT-CGM) in Type 2 Diabetes.
abstract: This analysis models the cost-effectiveness of real-time continuous glucose monitoring (RT-CGM) using evidence from a randomized controlled trial (RCT) that demonstrated RT-CGM reduced A1C, for up to 9 months after using the technology, among patients with type 2 diabetes not on prandial insulin. RT-CGM was offered short-term and intermittently as a self-care tool to inform patients' behavior.
  
  
  
  The analyses projected lifetime clinical and economic outcomes for RT-CGM versus self-monitoring of blood glucose by fingerstick only. The base-case analysis was consistent with the RCT (RT-CGM for 2 weeks on/1 week off over 3 months). A scenario analysis simulated outcomes of an RT-CGM "refresher" after the active intervention of the RCT. Analyses used the IMS CORE Diabetes Model and were conducted from a US third-party payer perspective, including direct costs obtained from published sources and inflated to 2011 US dollars. Costs and health outcomes were discounted at 3% per annum.
  
  
  
  Life expectancy (LE) and quality-adjusted life expectancy (QALE) from RT-CGM were 0.10 and 0.07, with a cost of $653/patient over a lifetime. Incremental LE and QALE from a "refresher" were 0.14 and 0.10, with a cost of $1312/patient over a lifetime, and incremental cost-effectiveness ratios were $9319 and $13 030 per LY and QALY gained.
  
  
  
  RT-CGM, as a self-care tool, is a cost-effective disease management option in the US for people with type 2 diabetes not on prandial insulin. Repeated use of RT-CGM may result in additional cost-effectiveness.
authors: Walter Reed National Military Medical Center, Bethesda, MD, USA fondasj@gmail.com.
authors: Stephanie J
authors: SJ
authors: Fonda
authors: Dexcom, Inc, San Diego, CA, USA.
authors: Claudia
authors: C
authors: Graham
authors: IMS Health, San Francisco, CA, USA.
authors: Julie
authors: J
authors: Munakata
authors: University of Colorado Denver, Aurora, CO, USA.
authors: Julia M
authors: JM
authors: Powers
authors: Dexcom, Inc, San Diego, CA, USA.
authors: David
authors: D
authors: Price
authors: Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors: Robert A
authors: RA
authors: Vigersky
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring / Q000191:economics; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic
chemical_list: D001786:Blood Glucose
keywords: behavior; continuous glucose monitoring; cost-effectiveness; health economics; self-care; self-monitoring