Cost-Utility Analysis of FreeStyle Libre Systems in People with Type 2 Diabetes Mellitus on Treatment with Basal Insulin and Poor Glycemic Control in Spain
IntroductionFreeStyle Libre (FSL) systems are effective and user-friendly glucose monitoring devices. This cost-effectiveness analysis compared FSL vs. self-blood glucose monitoring (SBGM) in patients with poorly controlled [hemoglobin A1c (HbA1c) > 8%] type 2 diabetes (T2DM) on basal insulin, fr...
| Autores: | , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2025 |
| País: | España |
| Institución: | INCLIVA |
| Repositorio: | r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA |
| OAI Identifier: | oai:incliva.fundanetsuite.com:p20477 |
| Acceso en línea: | https://incliva.portalinvestigacion.com/publicaciones/20477 |
| Access Level: | acceso abierto |
| Palabra clave: | Basal insulin therapy Cost-effectiveness analysis Cost-utility analysis Glucose monitoring FreeStyle Libre systems Poor glycemic control Self-blood glucose monitoring Spain Type 2 diabetes mellitus |
| Sumario: | IntroductionFreeStyle Libre (FSL) systems are effective and user-friendly glucose monitoring devices. This cost-effectiveness analysis compared FSL vs. self-blood glucose monitoring (SBGM) in patients with poorly controlled [hemoglobin A1c (HbA1c) > 8%] type 2 diabetes (T2DM) on basal insulin, from the Spanish National Health System perspective. MethodsThe DEDUCE model, which simulated 10,000 patients with T2DM over a 50 years' time horizon (annual discount rate = 3.00%), was adapted to the Spanish setting. The population characteristics, frequency of acute and chronic diabetic complications, costs (<euro>, 2025) and utilities/disutilities proceeded from scientific literature and were validated by national multidisciplinary experts. The annual probabilities of acute events associated with SBGM were 17.02% for non-severe hypoglycemia (SHE) (<euro>3.92; disutility = - 0.0016), 2.50% for SHE (<euro>1031.69; disutility = - 0.0470) and 0.25% for ketoacidosis (DKA) (<euro>2523.93; disutility = - 0.0470). The RECODe risk engine was used to model chronic diabetic complications (myocardial infarction [<euro>1248.44-<euro>31,013.22; disutility = - 0.0550]; heart failure [<euro>1523.14-6505.08; disutility = - 0.1080]; stroke [<euro>3187.92-7849.48; disutility = - 0.1640]; blindness [<euro>2943.37; disutility = - 0.0740]; renal failure [<euro>4057.05-42,757.39; disutility = - 0.2040]). According to the Spanish recommendations, a patient with SBGM required 2.5 reactive strips/day and 2.5 lancets/day (<euro>0.57/strip; <euro>0.14/lancet; VAT included). FSL (26 sensors/year; <euro>3.00/day; VAT included) was associated with reductions of 58% in hypoglycemia, 68% in DKA, 83% in the use of strips/lancets, and an absolute decrease of 1.1% in HbA1c. Deterministic and probabilistic sensitivity analyses (SAs) were conducted. ResultsWhile SBGM yielded 9.18 quality-adjusted life years (QALYs) and total costs of <euro>77,092 (glucose monitoring = <euro>17,080; diabetic complications = <euro>68,272), FSL yielded 9.98 QALYs and total costs of <euro>61,447 (glucose monitoring = <euro>8820; diabetic complications = <euro>44,367). Compared with SBGM, FSL produced total cost savings of <euro>15,645 and 0.80 additional QALYs per patient, being a dominant alternative compared to SBGM. FSL was found to be dominant in all SAs. ConclusionsThis analysis suggests that FSL, which provides better clinical outcomes at a lower overall cost, is a preferable alternative to SBGM among people with poorly controlled T2DM on basal insulin. |
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