1936-P: Cost Utility of Real-Time Continuous Glucose Monitoring (RT-CGM) vs. Self-Monitoring of Blood Glucose (SMBG) in People with Type 2 Diabetes Not on Insulin Therapy (T2D NIT) in the USA

Introduction and Objective: RT-CGM improved glycemic outcomes in people with T2D NIT in RCTs and real-world studies. However, it is unknown if RT-CGM would be a cost-effective strategy in T2D NIT from a commercial payer perspective in the USA. We conducted a cost-utility analysis (CUA) of RT-CGM compared to SMBG for T2D NIT from a US commercial payer perspective. Methods: A 50-year analysis with a 3% annual discount was conducted using the IQVIA Core Diabetes Model. Key baseline characteristics and clinical efficacy for RT-CGM were sourced from Cox, et al. (PMID 33094208) and for SMBG from McIntosh, et al. (PMID 21686299). HbA1c reductions in the RT-CGM and SMBG arms were -1.1% and -0.25%, respectively. Escalation to basal insulin and subsequently to bolus insulin was modeled when HbA1c exceeded 8.5%. After insulin initiation, severe hypoglycemic event (SHE) and diabetic ketoacidosis (DKA) rates were modeled based on a large retrospective study by Karter et al. (PMID 34077502). All cost data were sourced from previously published CUAs. Results: RT-CGM use was associated with an incremental quality adjusted life year (QALY) gain of 0.548 and incremental cost of $18,810 resulting in an incremental cost-utility ratio (ICUR) of $34,299/QALY. The ICUR is below the commonly cited willingness to pay threshold in the USA of $50,000/QALY. RT-CGM users are expected to incur lifetime savings of $19,258 per patient due to reductions in SHE, DKA, and micro- and macrovascular complications. Conclusion: From a commercial payer perspective, RT-CGM demonstrates meaningful cost-utility in the T2D NIT population. Disclosure S. Ilham: Employee; Current; Dexcom, Inc. G. Norman: Employee; Current; Dexcom, Inc. Stock/Shareholder; Current; Dexcom, Inc.