Cost Utility Analysis of the Flash Glucose Monitoring System in the Management of People With Type 2 Diabetes Mellitus on Basal Insulin Therapy—An Italian Healthcare System Perspective
Author(s)
Mennini FS1, Del Prato S2, Giorgino F3, Poon Y4, Szafranski K5
1Economic Evaluation and HTA (EEHTA CEIS), Department of Economics and Finance, Faculty of Economics, University of Rome “Tor Vergata”, ROMA, RM, Italy, 2Sant’Anna School of Advanced Studies, Pisa, Pisa, Italy, 3University of Bari Aldo Moro, Bari, BA, Italy, 4Abbott, Alameda, CA, USA, 5EVERSANA, Burlington, ON, Canada
Presentation Documents
OBJECTIVES: Optimal management of glucose is important to people living with Type 2 diabetes mellitus (T2DM) to help reduce disease burden and costly healthcare complications. Glucose monitoring remains an essential component of patient self-management to help reach and maintain targeted glucose and glycated haemoglobin (HbA1c) levels. The FreeStyle Libre system (FSL) was designed to reduce burden of glucose monitoring and is currently reimbursed in Italy for people with T2DM on multiple daily insulin injections, except in Sicily where it is also reimbursed for people on basal insulin only. This analysis was performed to assess cost utility of FSL compared to self-monitoring of blood glucose (SMBG) for people with T2DM on basal insulin, from an Italian healthcare system perspective.
METHODS: A patient-level microsimulation model was run using Microsoft Excel for 10,000 patients over a lifetime horizon with 3.0% cost- and 0% utility discounting. Patient characteristics (mean age, 68.1 years; mean HbA1c, 8.7%) were based on Italian population data, randomized controlled trials, and real-world evidence. Annual costs (€ 2023) comprised FSL and SMBG acquisition, complications, and acute diabetic events (ADEs; severe hypoglycaemia and diabetic ketoacidosis). The effect of FSL was modelled as a persistent 0.8% reduction in HbA1c relative to SMBG. Disutilities were applied annually for complications and per event for ADEs. Outcomes were assessed as quality-adjusted life years (QALYs).
RESULTS: Total costs were €4,602 higher with FSL than with SMBG (€62,085 vs €57,483). FSL was associated with increase of 0.69 QALYs, generating an incremental cost-effectiveness ratio (ICER) of €6,641/QALY. Scenario analyses ICERs ranged from €2,433/QALY to €25,315/QALY. In probabilistic analysis, FSL was 93% likely to be cost-effective at a willingness-to-pay threshold of €10,000/QALY, and 100% likely at thresholds >€15,000/QALY.
CONCLUSIONS: With respect to the Italian healthcare system, FSL is cost effective compared to SMBG for T2DM on basal insulin therapy.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 11, S2 (December 2023)
Code
EE19
Topic
Economic Evaluation, Medical Technologies, Study Approaches
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis, Decision Modeling & Simulation, Medical Devices
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), No Additional Disease & Conditions/Specialized Treatment Areas