1035-P: Cost-Effectiveness of Real-Time CGM vs. Self-Monitoring of Blood Glucose in People with Insulin-Treated Type 2 Diabetes from a U.S. Payor Perspective

Introduction: Diabetes and its complications cost the US healthcare system 412. 9 billion in 2022. The use of RT-CGM systems in diabetes management is associated with improvements in glycemic outcomes for people with insulin-treated T2D. We aim to investigate the cost-effectiveness of RT-CGM systems from a US payor perspective. Methods: Using the IQVIA Core Diabetes Model v10. 0, we projected clinical outcomes and direct medical costs over a lifetime horizon from a US payor perspective. Cohort characteristics and clinical inputs were sourced from a large US retrospective cohort study. Clinical parameters include an A1C effect of -0. 56% favoring 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 glucose monitoring are based on Medicare pricing and 80% reimbursement (HCPCS codes A4239 and A4253). 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: The model projects RT-CGM users to have higher quality-adjusted life years by 0. 769 with incremental costs of 16, 019, and an incremental cost-effectiveness ratio (ICER) of 20, 825, which is below the willingness to pay threshold (WTP) of 50, 000. The relative reduction in the total number of events due to RT-CGM use for diabetes eye, renal, neuropathy, and cardiovascular complications was 17. 0%, 20. 0%, 8. 7%, and 2. 4% respectively. RT-CGM remained cost-effective under the 50, 000 WTP even when its cost was increased by 85% (+2, 097). Sensitivity analysis for reducing RT-CGM costs by 10%, 20%, and 30% resulted in ICERs of 17, 425, 14, 020, and 10, 616 respectively. Conclusions: RT-CGM systems are cost-effective and project cost-savings due to a reduction in acute diabetes events, and microvascular and macrovascular complications. Our findings support access to RT-CGM in US payor policies. Disclosure H. Alshannaq: Employee; Dexcom, Inc. Stock/Shareholder; Unicycive Therapeutics. G. J. Norman: Employee; Dexcom, Inc. P. M. Lynch: Employee; Dexcom, Inc. Stock/Shareholder; Dexcom, Inc.