Economic analyses of freestyle libre systems for people living with diabetes: a systematic literature review

This study systematically reviewed economic evaluations of FreeStyle Libre systems (FSL) for glucose monitoring among people living with type 1 (T1DM) or type 2 diabetes mellitus (T2DM). Systematic searches were conducted on 27 February 2024 using the MEDLINE, Embase, and Cochrane databases. Study selection was conducted by two reviewers who independently reviewed titles, abstracts, and full article texts. Study quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist. In total, 18 cost-effectiveness studies were included; 17 were based on data for the original FSL device, with only one using FSL2 data. There were no major issues with study quality. The ten studies comparing FSL with self-monitoring of blood glucose (SMBG) reported FSL to be cost effective in populations with T1DM (seven studies) or T2DM (six studies). Eight studies reported other sensor-based systems to be cost effective versus FSL. Existing evidence suggests FSL systems are cost effective versus SMBG among people living with T1DM or T2DM on intensive insulin. Additional studies are needed to compare FSL systems with other sensor-based systems, considering the range of available evidence, the appropriateness of the compared devices, and the selection of modelling assumptions.