Cost-effectiveness of Continuous Glucose Monitoring for Adults With Type 1 Diabetes Compared With Self-Monitoring of Blood Glucose: The DIAMOND Randomized Trial
Cost-effectiveness of Continuous Glucose Monitoring for Adults With Type 1 Diabetes Compared With Self-Monitoring of Blood Glucose: The DIAMOND Randomized Trial
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DOI：
10.2337/dc17-1821
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发表时间：
2018-06-01
期刊：
影响因子：
16.2
通讯作者：
Huang, Elbert S.
中科院分区：
文献类型：
--
作者：
Wan, Wen;Skandari, M. Reza;Huang, Elbert S.
研究设计和方法在糖尿病患者每日多次注射胰岛素和连续血糖监测(DIAMOND)试验中，158名T1D和HbA(1c)>；=7.5%的患者按2：1的比例随机分为CGM和对照组。参与者在基线和6个月时接受调查。进行了试验内和终生成本-效果分析。采用改进的谢菲尔德T1D策略模型模拟T1D并发症。结果在6个月的试验中，CGM组的QALY与对照组相似(0.462+/-0.05年对0.455+/-0.06年，P=0.61)。6个月的总成本为11,032美元(CGM)，而不是7,236美元(对照)。与对照组相比，CGM组的糖化血红蛋白(HbA1c)(0.60+/-0.74%差值)、非严重低血糖事件的日发生率(0.07DID，P=0.013)和试纸用量(0.55+/-1.5DID，P=0.04)显著降低。在寿命分析中，CGM预计将降低T1D并发症的风险，并使QALY增加0.54。总体人口的增量成本效益比(ICER)为每QALY 98,108美元。在现实世界中，通过将传感器的使用时间从7天延长到10天，ICER降低到每QALY 33,459美元。结论对于使用多次胰岛素注射但仍在经历次优血糖控制的T1D成年人，CGMisse在每QALY 100,000美元的支付意愿阈值下具有成本效益，血糖控制得到改善，非严重低血糖得到减少。
OBJECTIVEThis study evaluated the societal cost-effectiveness of continuous glucose monitoring (CGM) in patients with type 1 diabetes (T1D) using multiple insulin injections.RESEARCH DESIGN AND METHODSIn the Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes (DIAMOND) trial, 158 patients with T1D and HbA(1c) >= 7.5% were randomized in a 2: 1 ratio to CGM or control. Participants were surveyed at baseline and 6months. Within-trial and lifetime cost-effectiveness analyses were conducted. A modified Sheffield T1D policy model was used to simulate T1D complications. The main outcome was cost per quality-adjusted life-year (QALY) gained.RESULTSWithin the 6-month trial, the CGM group had similar QALYs to the control group (0.462 +/- 0.05 vs. 0.455 +/- 0.06 years, P = 0.61). The total 6-month costs were $11,032 (CGM) vs. $7,236 (control). The CGM group experienced reductions in HbA1c (0.60 +/- 0.74% difference in difference [DiD]), P < 0.01), the daily rate of nonsevere hypogly-cemia events (0.07 DiD, P = 0.013), and daily test strip use (0.55 +/- 1.5 DiD, P = 0.04) compared with the control group. In the lifetime analysis, CGM was projected to reduce the risk of T1D complications and increase QALYs by 0.54. The incremental cost-effectiveness ratio (ICER) was $98,108 per QALY for the overall population. By extending sensor use from 7 to 10 days in a real-world scenario, the ICER was reduced to $33,459 per QALY.CONCLUSIONSFor adults with T1D using multiple insulin injections and still experiencing suboptimal glycemic control, CGMiscost-effective at the willingness-to-pay threshold of $100,000 per QALY, with improved glucose control and reductions in nonsevere hypoglycemia.