Cost-effectiveness analysis of sensor-augmented pump therapy with low glucose-suspend in patients with type 1 diabetes mellitus and high risk of hypoglycemia in Spain.

OBJECTIVE: To compare the cost-effectiveness of sensor-augmented pump therapy (SAP) [continuous subcutaneous insulin infusion (CSII) plus real-time continuous glucose monitoring (RT-CGM)] with low glucose suspend (MiniMed™ Veo™) and CSII alone in patients with type 1 diabetes mellitus (T1DM) at high risk of hypoglycemia in Spain. METHODS: The IQVIA CORE Diabetes Model was used to estimate healthcare outcomes as life-years gained (LYGs) and quality-adjusted life years (QALYs), and to project lifetime costs. Information about efficacy, resource utilization, and unit costs (€2016) was taken from published sources and validated by an expert panel. Analyses were performed from both the Spanish National Health System (NHS) perspective and the societal perspective. RESULTS: From the NHS perspective, SAP with low glucose suspend was associated to a €47,665 increase in direct healthcare costs and to increases of 0.19 LYGs and 1.88 QALYs, both discounted, which resulted in an incremental cost-effectiveness ratio (ICER) of €25,394/QALY. From the societal perspective, SAP with low glucose suspend increased total costs (including direct and indirect healthcare costs) by €41,036, with a resultant ICER of €21,862/QALY. Considering the willingness-to-pay threshold of €30,000/QALY in Spain, SAP with low glucose suspend represents a cost-effective option from both the NHS and societal perspectives. Sensitivity analyses confirmed the robustness of the model. CONCLUSIONS: From both the Spanish NHS perspective and the societal perspective, SAP with low glucose suspend is a cost-effective option for the treatment of T1DM patients at high risk of hypoglycemia.

Reimbursement for continuous glucose monitoring: a European view.

Different systems for continuous glucose monitoring (CGM) are available on the European market. There is no unlimited reimbursement for CGM use in any European country, but in some countries, reimbursement exists for certain clinical indications. The aim of this commentary is to describe the different reimbursement situations across Europe for this innovative but costly technology, as a prelude to establishing more uniform use. From the perspective of many scientists and clinicians, a number of randomized controlled trials have demonstrated the efficacy of real-time CGM versus self-monitoring of blood glucose, at least for hemoglobin A1c reduction. Nevertheless, according to many health care professionals and potential CGM users, national health services and health insurance organizations are reluctant to reimburse CGM. Imminent technological and manufacturing developments are expected to reduce the day-to-day costs of CGM.