The Cost-Effectiveness of Real-Time Continuous Glucose Monitoring (RT-CGM) in Type 2 Diabetes.
The Cost-Effectiveness of Real-Time Continuous Glucose Monitoring (RT-CGM) in Type 2 Diabetes.
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DOI：
10.1177/1932296816628547
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发表时间：
2016-07-01
影响因子：
5
通讯作者：
Vigersky, Robert A
中科院分区：
文献类型：
--
作者：
Fonda, Stephanie J;Graham, Claudia;Vigersky, Robert A
背景技术背景：该分析使用来自随机对照试验（RCT）的证据对实时连续葡萄糖监测（RT-CGM）的成本效益进行建模，该随机对照试验（RCT）表明，在未使用餐时胰岛素的2型糖尿病患者中，使用该技术后，RT-CGM可降低A1 C长达9个月。RT-CGM提供了短期和间歇性的自我保健工具，以告知患者的behavior.METHOD：分析预测的终身临床和经济后果RT-CGM与自我监测血糖的手指针刺。基础病例分析与RCT一致（3个月内RT-CGM给药2周/停药1周）。情景分析模拟了RCT积极干预后RT-CGM“复习”的结局。分析使用了IMS CORE糖尿病模型，并从美国第三方付款人的角度进行，包括从公开来源获得的直接成本，并将其夸大至2011年美元。成本和健康结果以每年3%的折扣率进行贴现。结果：预期寿命（LE）和质量调整预期寿命（QALE）从RT-CGM分别为0.10和0.07，与653美元/患者的一生成本。增量LE和QALE从一个“刷新”是0.14和0.10，与成本1312美元/患者的一生，和增量成本效益比分别为9319美元和13 030美元每LY和QALY gained.CONCLUSIONS：RT-CGM，作为一种自我保健工具，是一种具有成本效益的疾病管理选择在美国的人2型糖尿病不对餐时胰岛素。重复使用RT-CGM可能会带来额外的成本效益。
BACKGROUND: This analysis models the cost-effectiveness of real-time continuous glucose monitoring (RT-CGM) using evidence from a randomized controlled trial (RCT) that demonstrated RT-CGM reduced A1C, for up to 9 months after using the technology, among patients with type 2 diabetes not on prandial insulin. RT-CGM was offered short-term and intermittently as a self-care tool to inform patients' behavior.METHOD: The analyses projected lifetime clinical and economic outcomes for RT-CGM versus self-monitoring of blood glucose by fingerstick only. The base-case analysis was consistent with the RCT (RT-CGM for 2 weeks on/1 week off over 3 months). A scenario analysis simulated outcomes of an RT-CGM "refresher" after the active intervention of the RCT. Analyses used the IMS CORE Diabetes Model and were conducted from a US third-party payer perspective, including direct costs obtained from published sources and inflated to 2011 US dollars. Costs and health outcomes were discounted at 3% per annum.RESULTS: Life expectancy (LE) and quality-adjusted life expectancy (QALE) from RT-CGM were 0.10 and 0.07, with a cost of $653/patient over a lifetime. Incremental LE and QALE from a "refresher" were 0.14 and 0.10, with a cost of $1312/patient over a lifetime, and incremental cost-effectiveness ratios were $9319 and $13 030 per LY and QALY gained.CONCLUSIONS: RT-CGM, as a self-care tool, is a cost-effective disease management option in the US for people with type 2 diabetes not on prandial insulin. Repeated use of RT-CGM may result in additional cost-effectiveness.