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Title: Cost-effectiveness analysis of real-time continuous monitoring glucose compared to self-monitoring of blood glucose for diabetes mellitus in Spain
Authors: García Lorenzo,Borja 
Rivero-Santana, Amado
Vallejo Torres, Laura 
Castilla-Rodríguez, Iván
García-Pérez, Sonia
García-Pérez, Lidia
Perestelo-Pérez, Lilisbeth
UNESCO Clasification: 32 Ciencias médicas
Keywords: Cost‐effectiveness
Decision model
Diabetes mellitus
Real‐time continuous glucose monitoring
Self‐monitoring of blood glucose
Issue Date: 2018
Publisher: 1356-1294
Journal: Journal of Evaluation in Clinical Practice 
Abstract: Rationale, aims and objectives: Self-monitoring of blood glucose (SMBG) is recommended to monitor glycaemic levels. The recent development of real-time continuous glucose monitoring (RT-CGM) enables continuous display of glucose concentration alerting patients in the event of relevant glucose fluctuations, potentially avoiding hypoglycaemic events and reducing long-term complications related to glycosylated haemoglobin (HbA1c) levels. This paper aims to evaluate the cost-effectiveness of RT-CGM compared to SMBG in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) which should support decision-making on public funding of RT-CGM in Spain. Methods: We performed a systematic review and meta-analyses on the effectiveness of RT-CGM in the reduction of HbA1c levels and severe hypoglycaemic events. A cost-effectiveness analysis was conducted using a Markov model which simulates the costs and health outcomes of individuals treated under these alternatives for a lifetime horizon from the perspective of the Spanish Health Service. The effectiveness measure was quality-adjusted life years (QALYs). We ran extensive sensitivity analyses, including a probabilistic sensitivity analysis. Results: Real-time continuous glucose monitoring provides a significant reduction of HbA1c for T1DM (13 studies; weighted mean difference (WMD) = −0.23%, 95% CI: −0.35, −0.11) and T2DM (5 studies; WMD = −0.48%, 95% CI: −0.79, −0.17). There were no statistically significant differences in the rate of severe hypoglycaemic events in T1DM (9 studies; OR = 1.16, 95% CI: 0.78, 1.72) or T2DM (no severe hypoglycaemic events were reported in any study). In the base case analysis, RT-CGM led to higher QALYs and health care costs with an estimated incremental cost-effectiveness ratio of €2 554 723 and €180 553 per QALY for T1DM and T2DM patients respectively. Sensitivity analyses revealed that the study results were robust. Conclusions: Real-time continuous glucose monitoring is not a cost-effective technology when compared to SMBG in Spain.
ISSN: 1356-1294
DOI: 10.1111/jep.12987
Source: Journal of Evaluation in Clinical Practice [ISSN 1356-1294], v. 24 (4), p. 772-781
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