Abstract
BackgroundApps for real-time continuous glucose monitoring (CGM) on smartphones and other devices linked to CGM systems have recently been developed, and such CGM apps are also coming into use in Japan. In comparison with conventional retrospective CGM, the use of CGM apps improves patients’ own blood glucose control, which is expected to help slow the progression of type 2 diabetes mellitus (DM) and prevent complications, but the effect of their introduction on medical costs remains unknown.ObjectiveOur objective in this study was to perform an economic appraisal of CGM apps from the viewpoint of assessing public medical costs associated with type 2 DM, using the probability of developing type 2 DM–associated complications, and data on medical costs and utility value to carry out a medical cost simulation using a Markov model in order to ascertain the cost-effectiveness of the apps.MethodsWe developed a Markov model with the transition states of insulin therapy, nephrosis, dialysis, and cardiovascular disease, all of which have a major effect on medical costs, to identify changes in medical costs and utility values resulting from the introduction of a CGM app and calculated the incremental cost-effectiveness ratio (ICER).ResultsThe ICER for CGM app use was US $33,039/quality-adjusted life year (QALY).ConclusionsSensitivity analyses showed that, with the exception of conditions where the transition probability of insulin therapy, utility value, or increased medical costs increases, the ICER for the introduction of CGM apps was below the threshold of US $43,478/QALY used by the Central Social Insurance Medical Council. Our results provide basic data on the cost-effectiveness of introducing CGM apps, which are currently starting to come into use.
Highlights
According to a 2016 World Labour and Welfare Quality-Adjusted Life Years (QALY) (Health) Organization (WHO) global report of patients with type 2 diabetes mellitus (DM), there are currently over 420 million people with this condition worldwide, a 3.9-fold increase compared with 1980 [1]
One current method of hypoglycemia management for patients with type 2 DM is retrospective continuous glucose monitoring (CGM), in which blood glucose measurements over a certain period are aggregated and the user examines them after the event to determine any trends [8,9,10], but this method entails measuring blood glucose levels at regular intervals, and checking blood glucose levels in real time and taking measures to avert hypoglycemia or other conditions are difficult tasks
Apps for real-time CGM on smartphones and other devices linked to CGM systems have recently been developed, and such CGM apps are coming into use in Japan
Summary
According to a 2016 World Health Organization (WHO) global report of patients with type 2 diabetes mellitus (DM), there are currently over 420 million people with this condition worldwide, a 3.9-fold increase compared with 1980 [1]. Clinical trials are currently underway to investigate the clinical effectiveness of CGM apps in actual use, such as whether they reduce the incidence of complications or have any effect on HbA1c levels, and it is hoped that, in comparison with conventional retrospective CGM, they may help delay the progression of type 2 DM and control complications by improving patients’ own blood glucose control, enabling real-time patient guidance and family members to monitor patients’ blood glucose levels In advance of their introduction, simulations to establish their effect on medical costs will be required. Our results provide basic data on the cost-effectiveness of introducing CGM apps, which are currently starting to come into use
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