OBJECTIVE Maintaining healthy glucose levels is critical for the management of type 1 diabetes (T1D), but the most efficacious and cost-effective approach (capillary self-monitoring of blood glucose [SMBG] or continuous [CGM] or intermittently scanned [isCGM] glucose monitoring) is not clear. We modeled the population-level impact of these three glucose monitoring systems on diabetes-related complications, mortality, and cost-effectiveness in adults with T1D in Canada. RESEARCH DESIGN AND METHODS We used a Markov cost-effectiveness model based on nine complication states for adults aged 18–64 years with T1D. We performed the cost-effectiveness analysis from a single-payer health care system perspective over a 20-year horizon, assuming a willingness-to-pay threshold of CAD 50,000 per quality-adjusted life-year (QALY). Primary outcomes were the number of complications and deaths and the incremental cost-effectiveness ratio (ICER) of CGM and isCGM relative to SMBG. RESULTS An initial cohort of 180,000 with baseline HbA1c of 8.1% was used to represent all Canadians aged 18–64 years with T1D. Universal SMBG use was associated with ∼11,200 people (6.2%) living without complications and ∼89,400 (49.7%) deaths after 20 years. Universal CGM use was associated with an additional ∼7,400 (4.1%) people living complications free and ∼11,500 (6.4%) fewer deaths compared with SMBG, while universal isCGM use was associated with ∼3,400 (1.9%) more people living complications free and ∼4,600 (2.6%) fewer deaths. Relative to SMBG, CGM and isCGM had ICERs of CAD 35,017/QALY and 17,488/QALY, respectively. CONCLUSIONS Universal use of CGM or isCGM in the Canadian T1D population is anticipated to reduce diabetes-related complications and mortality at an acceptable cost-effectiveness threshold.

中文翻译：

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连续血糖监测和间歇扫描连续血糖监测技术对加拿大 1 型糖尿病患者的人群水平影响和成本效益：一项建模研究

目标 维持健康的血糖水平对于 1 型糖尿病 (T1D) 的管理至关重要，但最有效和最具成本效益的方法（毛细血管自我监测血糖 [SMBG] 或连续 [CGM] 或间歇扫描 [isCGM] 葡萄糖监控）不清楚。我们模拟了这三种血糖​​监测系统对加拿大 T1D 成人糖尿病相关并发症、死亡率和成本效益的影响。研究设计和方法 我们使用马尔科夫成本效益模型，该模型基于 18-64 岁 T1D 成人的九种并发症状态。我们假设每个质量调整生命年 (QALY) 的支付意愿阈值为 50,000 加元，从单一支付者医疗保健系统的角度进行了 20 年的成本效益分析。主要结果是并发症和死亡的数量以及 CGM 和 isCGM 相对于 SMBG 的增量成本效益比 (ICER)。结果 使用 180,000 名基线 HbA1c 为 8.1% 的初始队列来代表所有 18-64 岁患有 T1D 的加拿大人。普遍使用 SMBG 与 20 年后 11,200 人（6.2%）无并发症生活和 89,400 人（49.7%）死亡相关。与 SMBG 相比，普遍使用 CGM 与多 7,400 人（4.1%）无并发症和减少 11,500 人（6.4%）死亡相关，而普遍使用 isCGM 与多 3,400 人（1.9%）无并发症和无并发症相关约 4,600 (2.6%) 人死亡。相对于 SMBG，CGM 和 isCGM 的 ICER 分别为 35,017 加元/QALY 和 17,488/QALY。