Endocrine Abstracts

Introduction: We conducted a prospective study to compare the efficacy of continuous glucose monitoring (CGM) devices versus capillary blood glucose (CBG) in the glycemic control of inpatient type 2 diabetes on intensive insulin therapy. The use of CGM was associated with improved glycemic control, including an increased time in range (TIR) and reduced hyperglycemic events, being safe concerning hypoglycemias. The present study is the cost-effectiveness analysis associated with these results.

Aim: The primary objective was to compare the cost-effectiveness of achieving glycemic control (defined as the number of patients within TIR goals) between both groups. Secondary endpoints included cost-effectiveness analyses of each of the TIR goals, for each percentual increment in TIR, for increasing the number of daily readings and for reducing inpatient glucose management costs.

Methods: Cost-effectiveness was evaluated by comparing the average cost-effectiveness ratio (ACER) between both groups and by calculating the incremental cost-effectiveness ratio (ICER). The interpretation of the ICER was based on willingness to pay threshold of 24,697.561 €/patient within TIR goal, according to Portugal’s 2023 gross domestic product per capita.

Results: CGM group had a significantly higher number of patients with glycemic control (10 vs 2, P= 0.021), despite no difference between groups regarding most of TIR goals, with exception for ‘Time above 250 < 5%’ (16 vs 4, P= 0.002). In the ACER comparison, CGM showed lower median cost per effect for the primary outcome (11.1 vs 34.9 € /patient). As for secondary outcomes, CGM achieved lower ACER for ‘Time in Range >70%’ (7.8 vs 11.6 € /patient), for ‘Time above 180 < 25%”: 7.4 vs 9.9 € /patient, and ‘Time above 250 < 5%”: 6.9 vs 17.4 € /patient). Regarding ICER, CGM costed more 156 € /patient in glycemic control than CBG, considered as acceptable within the cost-effectiveness analysis plane. As for secondary outcomes, only ‘hypoglycemia <4%’ ICER showed a negative cost-effectiveness impact (-304 € /patient in glycemic control). The remaining were all positive and considered below the WTP threshold line.

Conclusions: There are no published data regarding the cost-effectiveness of CGM in inpatient settings. Our study suggests that the use of CGM may be more cost-effective inpatient diabetes glycemic control than CBG monitoring. CGM devices were associated with an improved glycemic control, mainly in reducing hyperglycemia, at a lower cost. Our results endorse the feasibility of incorporating these devices into the context of Portugal’s national healthcare, presenting a favorable cost-effective option compared to CBG monitoring.