Cost-effectiveness of stepped care compared to continuous glucose monitoring in hypoglycemia-prone individuals with type 1 diabetes - 03/06/26
, Harold W. de Valk, J. Hans DeVries, Thomas van Sloten, Frank J. Snoek, Maartje de Wit, Judith E. Bosmans
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Highlights |
• | CGM is increasingly used in type 1 diabetes with problematic hypoglycemia. |
• | Cost-effectiveness data from long-term prospective randomized studies are scarce. |
• | At 12 months, stepped care was less costly and less effective than immediate CGM use. |
• | Findings support immediate CGM over stepped care from cost-effectiveness perspective. |
Abstract |
Aims |
To assess the cost-effectiveness of stepped care (education program plus continuous glucose monitoring (CGM) as needed), compared to immediate CGM use.
Methods |
Analyses were conducted from a societal perspective over a 12-month horizon. Data were used from the Ecspect-Hypo randomized clinical trial, including 52 individuals with type 1 diabetes (T1D) and impaired hypoglycemia-awareness or a history of recent severe hypoglycemic events (SHEs) (mean age 53 years; 56% female). Outcomes included self-reported SHEs, quality-adjusted life years (QALYs) based on the EuroQol questionnaire, and costs were assessed using Tic-P questionnaires. Incremental cost-effectiveness ratios (ICERs) were calculated and cost-effectiveness acceptability curves were estimated.
Results |
After 12 months, stepped care resulted in more SHEs (mean difference 0.33, 95%CI 0.056;0.60), less QALYs (mean difference -0.12, 95%CI -0.23;-0.0045), and lower societal costs (mean difference €-252, 95%CI -921;656) compared to CGM. The ICER per prevented SHE was €769, and per QALY gained €5518. The probability that stepped care was cost-effective compared to CGM use was 0.73 at a willingness to pay (WTP) of €0/SHE prevented and per individual with restored hypoglycemia-awareness, and 0.14 at €20,000/QALY gained.
Conclusions |
Over 12 months, at a WTP threshold of €20,000/QALY, stepped care was not cost-effective compared to immediate CGM use in hypoglycemia-prone individuals with T1D.
Le texte complet de cet article est disponible en PDF.Keywords : Cost effectiveness, Blood glucose awareness training, Continuous glucose monitoring, Hypoglycemia, Impaired hypoglycemia awareness
Plan
Vol 21
Article 100319- 2026 Retour au numéro
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