Wan W, et al. - During this Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes (DIAMOND) trial, experts gauged the societal cost-effectiveness of continuous glucose monitoring (CGM) in subjects with type 1 diabetes (T1D) using multiple insulin injections. It was inferred that CGM was cost-effective at the willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY) for adults with T1D using multiple insulin injections and still experiencing suboptimal glycemic control. It led to improved glucose control and reductions in nonsevere hypoglycemia.

Methods

• Randomization was conducted of 158 patients with T1D and HbA1c ≥7.5% in a 2:1 ratio to CGM or control in the Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes (DIAMOND) trial.
• Enrollees were surveyed at baseline and 6 months.
• A within-trial and lifetime cost-effectiveness analyses were carried out.
• A modified Sheffield T1D policy model assisted in simulating T1D complications.
• Cost per quality-adjusted life-year (QALY) gained served as the main outcome.

Results

• CGM group displayed similar QALYs to the control group (0.462 ± 0.05 vs 0.455 ± 0.06 years, P=0.61).
• It was determined that the total 6-month costs were $11,032 (CGM) vs $7,236 (control).
• Reductions in HbA1c (0.60 ± 0.74% difference in difference [DiD]), P < 0.01), the daily rate of nonsevere hypoglycemia events (0.07 DiD, P=0.013), and daily test strip use (0.55 ± 1.5 DiD, P=0.04) was found in the CGM group compared with the control group.
• As per the lifetime analysis, CGM appeared to reduce the risk of T1D complications and increase QALYs by 0.54.
• Data illustrated that the incremental cost-effectiveness ratio (ICER) was $98,108 per QALY for the overall population.
• It was inferred that by extending sensor use from 7 to 10 days in a real-world scenario, the ICER was reduced to $33,459 per QALY.