PMD53 Modeling the Health and Economic Conseqences of Self-Monitoring of Blood Glucose (SMBG) in Non-Insulin Treated Patients With Type 2 Diabetes Mellitus (T2DM) in Spain

Abstract

Evidence from recent clinical studies has shown the benefits of SMBG plus a structured testing program (SMBG+STG) in non-insulin treated patients with T2DM. The Structured Testing Protocol (STeP) study found SMBG+STG can lead to improvements in glycemic control. This study assessed the cost-effectiveness of SMBG+STG versus SMBG alone from the Spanish health care system perspective in the context of recent studies of SMBG that have employed active education programs. A discrete event simulation model was developed to simulate the economic and health outcomes based on A1c changes related to using SMBG+STG or SMBG alone. Baseline A1c (8.4%) changes over 1 year (-1.2% and -0.9% for SMBG+STG versus SMBG alone), discontinuation and hypoglycemia rates were from the STeP study. Population and cost inputs were from published Spanish sources. Over a lifetime horizon (>30yrs), the model predicts: diabetes related complications (cardiovascular disease, stroke, amputations, end stage renal disease), hypoglycemia, life years (LYs) and quality adjusted life years (QALYs). Costs associated with events were estimated. Benefits and costs were discounted at 5%. Uncertainty in model estimates, such as changes in price per strip, treatment groups, program component, and A1c differences, was explored with sensitivity analyses. SMBG+STG was predicted to reduce complications and associated costs. Lowering A1c and consequent complications prevention with SMBG+STG translated into a dominant incremental cost-effectiveness ratio. Comparisons with a group not utilizing SMBG yielded similar results. In the long term, SMBG+STG is a cost-effective option compared to SMBG alone. An A1c reduction of 0.3% is a cost-effective outcome. Decison makers should consider designing programs to educate patients about SMBG+STG.