Cost-effectiveness of continuous glucose monitoring and intensive insulin therapy for type 1 diabetes

Cost Effectiveness and Resource Allocation

Patrick W Sullivan¹  Kavita V Nair³  Jonathan D Campbell³  Samuel L Ellis²  R Brett McQueen³ 

[1] Department of Pharmacy Practice, Regis University, Denver, Colorado, USA;Department of Clinical Pharmacy, School of Pharmacy, University of Colorado Denver, Denver, Aurora, Colorado, USA;Pharmaceutical Outcomes Research Program, School of Pharmacy, University of Colorado Denver, Aurora, Colorado, USA

关键词: Self-Monitoring of Blood Glucose;    Cost-utility analysis;    Type 1 diabetes;    Continuous Glucose Monitoring;    Cost-effectiveness analysis;   

Others  :  821030
DOI  :  10.1186/1478-7547-9-13

 received in 2011-01-07, accepted in 2011-09-14,  发布年份 2011

【 摘 要 】

Background

Our objective was to determine the cost-effectiveness of Continuous Glucose Monitoring (CGM) technology with intensive insulin therapy compared to self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes in the United States.

Methods

A Markov cohort analysis was used to model the long-term disease progression of 12 different diabetes disease states, using a cycle length of 1 year with a 33-year time horizon. The analysis uses a societal perspective to model a population with a 20-year history of diabetes with mean age of 40. Costs are expressed in $US 2007, effectiveness in quality-adjusted life years (QALYs). Parameter estimates and their ranges were derived from the literature. Utility estimates were drawn from the EQ-5D catalogue. Probabilities were derived from the Diabetes Control and Complications Trial (DCCT), the United Kingdom Prospective Diabetes Study (UKPDS), and the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Costs and QALYs were discounted at 3% per year. Univariate and Multivariate probabilistic sensitivity analyses were conducted using 10,000 Monte Carlo simulations.

Results

Compared to SMBG, use of CGM with intensive insulin treatment resulted in an expected improvement in effectiveness of 0.52 QALYs, and an expected increase in cost of $23,552, resulting in an ICER of approximately $45,033/QALY. For a willingness-to-pay (WTP) of $100,000/QALY, CGM with intensive insulin therapy was cost-effective in 70% of the Monte Carlo simulations.

Conclusions

CGM with intensive insulin therapy appears to be cost-effective relative to SMBG and other societal health interventions.

【 授权许可】

   
2011 McQueen et al; licensee BioMed Central Ltd.

【 图 表 】

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