How Glucose Monitors Affect Healthcare Spending

Huang

Continuous glucose monitors (CGM) offer benefits to type 1 diabetes patients, such as measuring glucose in real time, but can be costly.

However, a new study, published April 12, 2018 in Diabetes Care, from the American Diabetes Association, found that continuous glucose monitoring is very cost-effective for patients with type 1 diabetes that use multiple daily injections.

“The device does increase healthcare costs but this is offset by the prevention of future costly complications,” says senior study author Elbert Huang, MD, associate director of the Chicago Center for Diabetes Translation Research at the University of Chicago. “Our cost-effectiveness analysis can be used in making decisions regarding coverage of CGM.”

Huang and colleagues were part of an investigative team that conducted a randomized trial of 158 patients with type 1 diabetes who relied on multiple, daily injections of insulin and not an insulin pump. Two-thirds of the group used CGMs, and the remaining third used the finger prick method with test strips and a meter to check their blood sugars.

At the end of the six-month trial, the total healthcare costs of using a CGM was $11,032, compared to $7,236 for manual testing. The cost differences were mostly because of the $2,500 upfront cost of the CGM device. But the CGM group saw reductions in their hemoglobin A1c levels, a common measure of blood sugar control, and experienced fewer non-severe low blood sugar events.

Long-term cost benefits

The researchers also used a statistical model to simulate the costs and health effects of CGM use over the lifetime of patients. The model calculated the years spent in high quality health (quality-adjusted life years (QALYs) for each patient. In this analysis, the CGM was projected to reduce the risk of complications from type 1 diabetes and add six months of good health, according to the authors.

The overall cost-effectiveness of a new technology or treatment is expressed by a ratio of the difference in costs over the health benefit it adds (per QALY). The ratio for the CGM was about $100,000 per QALY for the overall population. This is well below the threshold insurance plans and government agencies such as Medicare normally use to decide whether or not to cover a new treatment or medical device. When accounting for real-world use of the CGM which involves prolonging the use of a sensor from seven to 10 days, the ratio was reduced to about $33,000 per QALY.

“Our results are important in that organizations need to have the capacity to use new self-care technology such as CGM,” says Huang. “This capacity includes the ability to upload patient data, analyze the data that comes from these technologies, and incorporate all of this into the electronic medical record. The promise of the new technology is greater patient ownership of their chronic diseases that lowers future healthcare utilization.”

About a decade ago, the original trials and economic evaluations of CGM were done in patients with type 1 diabetes-many of whom had very good control of their diabetes using insulin pumps, according to Huang. 

“The [study] evaluated newer CGM technologies in patients with type 1 diabetes that used multiple daily injections. The majority of patients with type 1 diabetes actually use multiple daily injections. Prior to the conduct of [this study] it was not entirely clear that CGM would work the same as it did in older trials.”

Three takeaways

The clinical effects of CGM are unique, according to Huang. “CGM is really a tool that just provides more information to patients about their sugar levels,” he says. “It does not introduce more medication. With the mere provision of information, it lowers blood sugars and lowers the risk of hypoglycemia. That is a powerful combination of benefits with no harm.”

Based on the study, Huang has three takeaways for healthcare executives:

• Prepare for a future where big data gathered by technologies worn by patients can be incorporated into clinical practice.
• For payers, CGM is highly cost-effective technology that will become even more cost-effective with real-world use.
• Encourage self-care by patients living with chronic diseases is one key strategy for “solving the Rubik’s Cube of the Triple Aim-better health, better healthcare, at lower cost,” he says.