Cost-effectiveness of real time continuous glucose monitoring to target glucose control in preterm infants

Abstract

The optimal management of glucose levels in critical care remains an area for research due to the problems of balancing the risks of hyperglycemia versus hypoglycemia. This paper reports the first economic evaluation of real time continuous glucose monitoring to guide the clinical management of preterm infants, based on evidence from the REACT trial. Bivariate regression of costs (£, 2016-17 prices) and cases of adequate glucose control, with multiple imputation of missing data, was conducted. When the economic evaluation was restricted to the first week of life, real time continuous glucose monitoring was associated with increased costs and a statistically significant increase in adequate glucose control. When the assessment was performed over a time horizon extending to 36 weeks’ corrected gestational age, real time CGM was dominant in health economic terms, i.e. associated with lower costs and better outcomes. These results largely remained robust to a range of sensitivity analyses and sub-group analyses designed to address uncertainty and heterogeneity surrounding the cost-effectiveness outcomes. This study suggests that the use of real time continuous glucose monitoring in preterm infants is associated with a high probability of cost-effectiveness.