A Budget Impact Model Assessing Continuous Blood Glucose Monitoring Devices in Type 2 Diabetes Mellitus in Sweden

OBJECTIVES: To prevent hypoglycemia, hyperglycemia and long-term diabetes complications, keeping glucose levels within range is essential for individuals with type 2 diabetes mellitus (T2DM). This is traditionally done by self-monitoring of blood glucose (SMBG), involving finger pricking. However, continuous glucose monitoring (CGM) devices using a glucose sensor allow for better glucose control and lower the risk of hypoglycemia and hyperglycemia versus SMBG. The objective of this study was to assess the budget impact of replacing SMBG with CGM devices in T2DM, from a Swedish healthcare perspective.

METHODS: A budget impact model with a 5-year time horizon was developed to compare the costs associated with SMBG versus real-time CGM (rtCGM), and intermittent-scanning CGM (isCGM). The model population was based on the Swedish T2DM prevalence, annual incidence and CGM eligibility. Cost categories included device acquisition, drug acquisition, consumables, adverse events (AEs) and diabetes complications. Cost inputs were based on Swedish sources. Incidence of AEs were derived from the devices’ pivotal trials. The incidence of complications was based on risk equations, which were informed by patient characteristics and change in glucose levels based on a network meta-analysis between rtCGM, isCGM, and SMBG.

RESULTS: 105,000 hypothetical Swedish individuals with T2DM entered the model in year 1. Over a 5-year time horizon, replacing SMBG with rtCGM and isCGM led to cost savings of SEK 68,000,000, primarily due to lower costs for medication, AEs, and diabetes complications. rtCGM was associated with the highest cost savings thanks to better glycemic control, resulting in fewer diabetes complications versus SMBG and isCGM.

CONCLUSIONS: Controlling glucose levels with CGM, and with rtCGM particularly, could lower overall treatment costs in T2DM. In a disease area with rising prevalence, these savings highlight the potential for substantial economic benefit to the Swedish healthcare system by switching individuals with T2DM from SMBG to CGM.