Cost‐effectiveness analysis comparing real‐time continuous glucose monitoring with self‐monitoring of blood glucose for patients with type 2 diabetes treated with insulin in Japan

INTRODUCTION: Real-time continuous glucose monitoring (rt-CGM) systems are associated with reductions in glycated hemoglobin (HbA1c) and hypoglycemic events compared with self-monitoring of blood glucose (SMBG). This analysis aimed to assess the cost-effectiveness of rt-CGM compared with SMBG in the management of people with T2D who require insulin treatment in Japan. MATERIALS AND METHODS: A lifetime economic evaluation was conducted using the IQVIA Core Diabetes Model, version 10. Effectiveness data were obtained from a randomized controlled trial that showed rt-CGM reduced HbA1c by 0.9% compared to SMBG. Cohort characteristics and cost data were primarily sourced from Japanese studies. Costs were inflated to 2023 Japanese Yen (JPY) and discounted at 2.0% per annum. The robustness of the base case results was subsequently assessed through sensitivity analyses. RESULTS: In the base case, there was an incremental gain of 1.501 quality-adjusted life years (QALYs) favoring rt-CGM at an incremental cost of JPY 500,192, resulting in an incremental cost-effectiveness ratio (ICER) of JPY 333,150/QALY gained. This was far below the assumed willingness-to-pay (WTP) threshold of JPY 5,000,000/QALY gained. The result was robust in sensitivity analyses, with all scenarios tested also returning ICERs below the WTP threshold. When examining projected clinical outcomes, rt-CGM was associated with reductions in the incidence of the majority of complications considered. CONCLUSIONS: From a Japanese healthcare perspective, rt-CGM is highly cost-effective for the glycemic management of people with T2D who require insulin treatment.