174-OR: Budget Impact Analysis (BIA) Comparing Real-Time Continuous Glucose Monitoring (RT-CGM) with Self-Monitoring of Blood Glucose (SMBG) for all U.S. Medicaid Enrollees with Type 1 Diabetes

Abstract

A BIA was performed comparing clinical cost offsets for rt-CGM compared with SMBG for U.S. Medicaid enrollees with type 1 diabetes (T1D) over one year. Clinical effects for HbA1c reduction using rt-CGM (-1.0%) and SMBG (-0.4%) were taken from the DIAMOND randomized controlled trial, converted into an economic benefit, and inflated ($U.S. 2019). Reduced hospitalization rates for severe hypoglycemia (SH; -73%) and diabetic ketoacidosis (DKA; -80%) were taken from the RESCUE trial, a Belgian observational cohort study, where SMBG was used in the year prior to countrywide rt-CGM reimbursement and outcomes tracked for one year. Estimated cost savings for HbA1c reduction (low and high), SH and DKA hospitalizations were taken from published literature and inflated ($U.S. 2019). We tested various ranges of pricing for rt-CGM and SMBG. Switching all U.S. Medicaid enrollees with T1D from SMBG to rt-CGM would result in an estimated 51,796 and 21,253 fewer SH and DKA hospitalizations, respectively, per year. Applying the clinical cost offsets against the added cost for rt-CGM over SMBG resulted in cost savings in most scenarios. Our modelling study demonstrates the substantial clinical and economic benefits using rt-CGM over SMBG in all U.S. Medicaid enrollees with T1D. Disclosure M.E. Minshall: Consultant; Self; Dexcom, Inc. J.J. Isitt: Employee; Self; Dexcom, Inc. C. Graham: Consultant; Self; Dexcom, Inc., DreaMed Diabetes. P.M. Lynch: Employee; Self; Dexcom, Inc. Stock/Shareholder; Self; Dexcom, Inc. Funding Dexcom, Inc.