1036-P: Cost-Effectiveness of Real-Time CGM vs. Self-Monitoring of Blood Glucose in People with Type 2 Diabetes on Intensive Insulin Therapy in Australia

Introduction: Clinical studies show RT-CGM systems improve glucose management in people with T2D on intensive insulin therapy (IIT). Reimbursement for RT-CGM in Australia is currently limited to people with T1D. Our analysis examines the cost-effectiveness of RT-CGM for people with T2D IIT in Australia. Methods: We used the IQVIA Core Diabetes Model to simulate diabetes clinical outcomes and direct medical costs over a lifetime horizon from an Australian payor perspective. A large retrospective cohort study provided the cohort characteristics and treatment effects. The adjusted difference in A1C reduction was -0.56% for RT-CGM, severe hypoglycemic events rates of 0.04 and 0 Per Person-Year (PPY) for SMBG and RT-CGM, respectively, and DKA rates of 0.025 and 0 PPY, respectively. The costs of CGM are based on the Dexcom G6 RT-CGM list price in Australia. A utility for the avoidance of finger sticks (0.03) and fear of hypoglycemia reduction (0.025) were applied to users of RT-CGM. Results: RT-CGM users are projected to have higher quality-adjusted life years (QALYs) by 0.621 with AUD 14,117 incremental costs, and an incremental cost-effectiveness ratio (ICER) of 22,736, below the AUD 50,000 willingness-to-pay threshold for Australia. Microvascular and macrovascular outcomes projections indicate that RT-CGM use results in a relative reduction in diabetes eye, renal, neuropathy, and cardiovascular complications of 17.7%, 21.1%, 8.7%, and 2.5% respectively. Sensitivity analysis scenarios of RT-CGM cost reductions of 10%, 20%, and 30% resulted in ICERs of 17,976, 13,220, and 8,464, respectively. RT-CGM remained cost-effective even when its costs were increased by 30%. Conclusion: The use of RT-CGM systems for diabetes management in people with T2D on intensive insulin therapy results in significant cost savings due to the reduction of diabetes complications. These findings support expanding reimbursement for RT-CGM in Australia. Disclosure H. Alshannaq: Employee; Dexcom, Inc. Stock/Shareholder; Unicycive Therapeutics. M. Ahmed: None. G.J. Norman: Employee; Dexcom, Inc. D. Simmons: Speaker's Bureau; Abbott. Consultant; Sanofi. Speaker's Bureau; Ascensia Diabetes Care. Other Relationship; Ascensia Diabetes Care, Boehringer-Ingelheim. Research Support; Dexcom, Inc. Speaker's Bureau; Novo Nordisk. Research Support; Wests Club, NSW, Australia, Roche Diabetes Care.