目的:本研究的目的是评估具有警报功能的DexcomG6实时连续血糖监测(rtCGM)与无警报的FreeStyleLibre1间歇性扫描连续血糖监测(isCGM)在比利时1型糖尿病成人中的长期成本效益。
方法:使用IQVIACORE糖尿病模型来评估成本效益。模拟基线队列的输入数据来自随机ALERTT1试验(ClinicalTrials.gov.
背景:NCT03772600)。参与者的年龄为42.9±14.1岁(平均值±SD),基线HbA1c为57.8±9.5mmol/mol(7.4±0.9%)。使用rtCGM的参与者显示,基于6个月的组间平均差异,HbA1c降低了3.6mmol/mol(0.36个百分点)。在基本情况下,根据比利时的报销系统,rtCGM和isCGM的价格均为3.92欧元/天(不包括增值税[VAT])。该分析是从比利时医疗保健付款人的角度在一生的时间范围内进行的。健康结果表示为质量调整生命年。使用概率和单向敏感性分析来解释参数不确定性。
结果:在基本情况下,rtCGM占主导地位的是CGM,导致更低的糖尿病相关并发症成本和更好的健康结果。有利于rtCGM的相关主要驱动因素是较低的HbA1c,减少严重的低血糖事件,减少对低血糖的恐惧。在广泛的单向敏感性分析下,结果是稳健的。在rtCGM的价格为5.11欧元/天(价格上涨30.4%)或12.34欧元/天(价格上涨214.8%)的型号中,rtCGM是成本中性的,或达到每个质量调整生命年40,000欧元的增量成本效益比,分别。
结论:价格相似时,与FreeStyleLibre1isCGM相比,具有警报功能的DexcomG6rtCGM在比利时的1型糖尿病成年人中没有警报,具有经济和临床优势。并且似乎是一种具有成本效益的葡萄糖监测方式。试验注册ClinicalTrials.govNCT03772600。
OBJECTIVE: 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.
BACKGROUND: 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: 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.