OBJECTIVES: To identify and synthesize economic evaluations of FreeStyle Libre (FSL) continuous glucose monitoring (CGM) systems among people living with diabetes (PWD).

METHODS: A PRISMA-compliant search of the published economic evaluations of FSL systems among PWD was conducted in MEDLINE, Embase, and Cochrane databases. English language publications and letters from inception to February 2024 were included. Study characteristics, model design, model inputs, and outcomes were extracted from included studies. Quality was assessed using the Checklist for Health Economic Evaluation Reporting Standards (CHEERS).

RESULTS: This review synthesized evidence from 20 cost-effectiveness/cost-utility analyses (CEA/CUA). Studies were generally assessed as good quality, and 75% of the evaluations included people living with type 1 diabetes. Of included studies, 12 compared FSL systems with self-monitoring of blood glucose (SMBG), 3 with other CGMs, and 5 with advanced hybrid closed-loop (AHCL) systems. CEA/CUA analyses found FSL systems to be cost-effective compared to SMBG for PWD, including those on intensive and non-intensive insulin. Four studies comparing FSL and SMBG were not sponsored by industry, with three of these finding FSL cost-effective and one finding FSL dominant or cost-effective in most scenarios considered. CEA/CUA analyses between FSL without alarms and other CGMs showed the latter were more costly and effective. Other CEA/CUA studies showed AHCL systems were more costly and effective than FSL systems in people with multiple daily injections of insulin. In CEAs/CUAs comparing FSL to other CGMs and AHCL systems, potential limitations were noted, such as choice of treatment effect for FSL systems, and the use of evidence derived from older generations of FSL systems that did not have alarms.

CONCLUSIONS: Review findings underscore the need for comprehensive and objective economic evaluations of diabetes management technologies. The evidence suggests that FSL systems are cost-effective compared to SMBG in PWD.