Continuous Glucose Monitoring for People Living with Type 2 Diabetes Who Are Not on Insulin: A Budget Impact Analysis from a Medicare Perspective

Background: Two major drivers of diabetes health care costs are acute diabetes events and complications, the incidence of which may be reduced by effective glucose monitoring using continuous glucose monitoring (CGM) systems. CGM is currently reimbursed by Medicare for people with diabetes who are on insulin or those on non-insulin therapies who are at risk of hypoglycemia. Aim: To estimate the impact of increasing CGM use and expanding access to Medicare beneficiaries with type 2 diabetes (T2D) who are using insulin or non-insulin therapies. Methods: This budget impact analysis modeled the impact of expanding CGM use among all people with T2D, including those on multiple daily injections of insulin (MDI), basal insulin, and non-insulin therapies. Forecast uptake in years 1, 2, and 3, respectively, was 1%, 2%, and 3% for MDI and 5%, 10%, and 15% for basal insulin and non-insulin therapies. The incidence of all-cause hospitalizations (ACH) and all-cause emergency room (ACER) visits was taken from US real-world studies. Costs associated with glucose monitoring and ACH/ACER were included. Results: Of the estimated 16.3 million Medicare beneficiaries with T2D, 4.9 million are using insulin and 11.4 million are on non-insulin therapies. Per person per year, glucose monitoring with CGM costs an average of $3279, but reductions in ACH and ACER lead to overall savings of $18,780 for people with T2D using MDI, $2489 for those on basal insulin, and $1780 for those on non-insulin therapy. Overall, Medicare costs would be reduced by approximately $1.8 billion, $3.6 billion, and $5.6 billion in years 1, 2, and 3, respectively (3-year total, $10.9 billion). Conclusions: Investing in CGM use by Medicare enrollees living with T2D and expanding access to those using non-insulin therapies could result in substantial savings. These findings support expansion of CGM access to Medicare beneficiaries with T2D on any diabetes therapy.