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Cost–utility analysis of Dexcom G6 real-time continuous glucose monitoring versus FreeStyle Libre 1 intermittently scanned continuous glucose monitoring in adults with type 1 diabetes in Belgium

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Abstract

Aims/hypothesis

The aim of this study was to assess the long-term cost-effectiveness of Dexcom G6 real-time continuous glucose monitoring (rtCGM) with alert functionality compared with FreeStyle Libre 1 intermittently scanned continuous glucose monitoring (isCGM) without alerts in adults with type 1 diabetes in Belgium.

Methods

The IQVIA CORE Diabetes Model was used to estimate cost-effectiveness. Input data for the simulated baseline cohort were sourced from the randomised ALERTT1 trial (ClinicalTrials.gov. registration no. NCT03772600). The age of the participants was 42.9 ± 14.1 years (mean ± SD), and the baseline HbA1c was 57.8 ± 9.5 mmol/mol (7.4 ± 0.9%). Participants using rtCGM showed a reduction in HbA1c of 3.6 mmol/mol (0.36 percentage points) based on the 6-month mean between-group difference. In the base case, both rtCGM and isCGM were priced at €3.92/day (excluding value-added tax [VAT]) according to the Belgian reimbursement system. The analysis was performed from a Belgian healthcare payer perspective over a lifetime time horizon. Health outcomes were expressed as quality-adjusted life years. Probabilistic and one-way sensitivity analyses were used to account for parameter uncertainty.

Results

In the base case, rtCGM dominated isCGM, resulting in lower diabetes-related complication costs and better health outcomes. The associated main drivers favouring rtCGM were lower HbA1c, fewer severe hypoglycaemic events and reduced fear of hypoglycaemia. The results were robust under a wide range of one-way sensitivity analyses. In models where the price of rtCGM is €5.11/day (a price increase of 30.4%) or €12.34/day (a price increase of 214.8%), rtCGM was cost-neutral or reached an incremental cost-effectiveness ratio of €40,000 per quality-adjusted life year, respectively.

Conclusions/interpretation

When priced similarly, Dexcom G6 rtCGM with alert functionality has both economic and clinical benefits compared with FreeStyle Libre 1 isCGM without alerts in adults with type 1 diabetes in Belgium, and appears to be a cost-effective glucose monitoring modality.

Trial registration ClinicalTrials.gov NCT03772600

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Abbreviations

CEAC:

Cost-effectiveness acceptability curve

CGM:

Continuous glucose monitoring

CUA:

Cost–utility analysis

EQ-5D:

EuroQol 5-Dimension questionnaire

FoH:

Fear of hypoglycaemia

HFS-worry:

Hypoglycaemia Fear Survey version II worry subscale

ICER:

Incremental cost-effectiveness ratio

isCGM:

Intermittently scanned continuous glucose monitoring

MDI:

Multiple daily injections

PSA:

Probabilistic sensitivity analysis

QALY:

Quality-adjusted life year

rtCGM:

Real-time continuous glucose monitoring

SHE(s):

Severe hypoglycaemic event(s)

TIR:

Time in range

WTP:

Willingness-to-pay

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Authors and Affiliations

  1. Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium

    Margaretha M. Visser, Sara Charleer, Chantal Mathieu & Pieter Gillard

  2. Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium

    Astrid Van Muylder & Jeroen Luyten

  3. Vyoo Agency, San Diego, CA, USA

    John J. Isitt

  4. Vyoo Agency, Lyon, France

    Stéphane Roze

  5. Department of Endocrinology–Diabetology–Metabolism, University Hospital Antwerp, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium

    Christophe De Block

  6. Department of Endocrinology, Imeldaziekenhuis Bonheiden, Bonheiden, Belgium

    Toon Maes

  7. Department of Endocrinology, AZ Groeninge, Kortrijk, Belgium

    Gerd Vanhaverbeke

  8. Department of Endocrinology, OLV Hospital Aalst, Aalst, Belgium

    Frank Nobels

  9. Academic Hospital and Diabetes Research Centre, Vrije Universiteit Brussel, Brussels, Belgium

    Bart Keymeulen

  10. Research Institute for Work and Society, KU Leuven, Leuven, Belgium

    Nick Verhaeghe

  11. Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research, Ghent University, Ghent, Belgium

    Nick Verhaeghe

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  1. Margaretha M. Visser
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Correspondence to Pieter Gillard.

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Acknowledgements

University Hospitals Leuven (sponsor of the ALERTT1 trial) acted as sponsor of this study and received a research grant from Dexcom. Representatives of Dexcom reviewed the manuscript, but had no role in the study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit for publication. The authors would like to thank all the local investigators and their teams for collecting the data during the ALERTT1 trial. Some of the data were presented as an abstract at The Official Journal of ATTD Advanced Technologies & Treatments for Diabetes Conference in 2023.

Data availability

This cost–utility analysis is based on data from the original randomised controlled ALERTT1 trial. Please refer to the original manuscript for information on data availability [7].

Funding

University Hospitals Leuven acted as sponsor of the ALERTT1 trial and received a research grant from Dexcom. Dexcom provided the experimental rtCGM device and technical support (to study teams only) in the case of device issues.

Authors’ relationships and activities

UZ Leuven received non-financial support for travel from Novo Nordisk, and from Boehringer Ingelheim for MMV. MMV has served on the speakers bureau for Dexcom, and financial compensation for these activities has been received by KU Leuven. KU Leuven received research support from Roche Diabetes Care, Novo Nordisk and Sanofi for SC. JJI is an employee of Vyoo Agency USA, which has received consulting fees from Dexcom. SR is the CEO of Vyoo Agency, which has received consulting fees from Dexcom. CDB has received consulting fees and honoraria for speaking for Abbott, AstraZeneca, Boehringer Ingelheim, A. Menarini Diagnostics, Indigo Diabetes, Insulet, Eli Lilly, Medtronic, Novo Nordisk and Roche, and has served on advisory panels for Eli Lilly, Indigo Diabetes and Novo Nordisk. GV serves or has served on advisory panels for Merck Sharp and Dohme, Boehringer Ingelheim and Eli Lilly. GV has received consulting fees and honoraria for speaking from Merck Sharp and Dohme, Boehringer Ingelheim, AstraZeneca, Sanofi-Aventis, Novo Nordisk and Eli Lilly. FN has received consulting fees and honoraria for speaking from Abbott, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Johnson and Johnson, Medtronic, Merck Sharp and Dohme, Novo Nordisk, Roche and Sanofi-Aventis. CM serves or has served on advisory panels for Novo Nordisk, Sanofi, Merck Sharp and Dohme, Eli Lilly, Novartis, AstraZeneca, Boehringer Ingelheim, Roche, Medtronic, ActoBio Therapeutics, Pfizer, Imcyse, Insulet, Zealand Pharma, Avotres, Mannkind, Sandoz and Vertex. Financial compensation for these activities has been received by KU Leuven; KU Leuven has also received research support for CM from Medtronic, Imcyse, Novo Nordisk, Sanofi and ActoBio Therapeutics. CM also serves or has served on the speakers bureaux for Novo Nordisk, Sanofi, Eli Lilly, Boehringer Ingelheim, AstraZeneca and Novartis. Financial compensation for these activities has been received by KU Leuven. JL has acted as a technical advisor on economic evaluation of vaccines (for Pfizer and Merck Sharp and Dohme) and medically assisted reproduction (Merck), for which KU Leuven has received financial compensation. PG serves or has served on advisory panels for Novo Nordisk, Sanofi-Aventis, Boehringer Ingelheim, Janssen Pharmaceuticals, Roche, Medtronic, Abbott and Bayer. Financial compensation for these activities has been received by KU Leuven. PG serves or has served on the speakers bureaux for Merck Sharp and Dohme, Boehringer Ingelheim, Bayer, Medtronic, Insulet, Novo Nordisk, Abbott, Roche, VitalAire and Dexcom. Financial compensation for these activities has been received by KU Leuven. KU Leuven received non-financial support for travel for PG from Sanofi-Aventis, A. Menarini Diagnostics, Novo Nordisk, Medtronic and Roche. All disclosures are unrelated to the present work. AVM, TM, BK and NV declare that there are no relationships or activities that might bias, or be perceived to bias, their work.

Contribution statement

MMV and AVM contributed equally to this manuscript, both from their own professional expertise. MMV and AVM analysed and discussed the data, created figures and tables, and wrote the manuscript. JJI and SR performed statistical analyses, discussed the data, created figures and edited the manuscript. JL, PG and NV analysed and discussed the data, and wrote the manuscript. SC, CDB, TM, GV, FN, BK and CM analysed and discussed the data and edited the manuscript. MMV and PG are the guarantors of this work and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.

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Margaretha M. Visser and Astrid Van Muylder are joint first authors. Pieter Gillard and Nick Verhaeghe are joint senior authors.

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Visser, M.M., Van Muylder, A., Charleer, S. et al. Cost–utility analysis of Dexcom G6 real-time continuous glucose monitoring versus FreeStyle Libre 1 intermittently scanned continuous glucose monitoring in adults with type 1 diabetes in Belgium. Diabetologia 67, 650–662 (2024). https://doi.org/10.1007/s00125-023-06084-2

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