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

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.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.CGM with intensive insulin therapy appears to be cost-effective relative to SMBG and other societal health interventions.Diabetes mellitus and its complications continue to be a growing burden on the United States health care system. The American Diabetes Association (ADA) estimates that as of 2007, the prevalence of type 1 and 2 diabetes is over 24 million, growing at 1 million people diagnosed with diabetes per year since 2002 [1]. The ADA estimated an annual cost in 2007 of $174 billion due to diabetes, $116 billion of that due to direct medical costs of diabetes and chronic conditions related to diabetes [1]. There is an obvious need for reductions in costs related to diabetes while improving management of the disease, thus increasing the qua