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CMAJ. 2010 Jan 12;182(1):28-34. doi: 10.1503/cmaj.090765. Epub 2009 Dec 21.

Cost-effectiveness of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin.

Author information

1
Canadian Optimal Medication Prescribing and Utilization Service (COMPUS), Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Ont. chrisc@cadth.ca

Abstract

BACKGROUND:

The benefits of self-monitoring blood glucose levels are unclear in patients with type 2 diabetes mellitus who do not use insulin, but there are considerable costs. We sought to determine the cost effectiveness of self-monitoring for patients with type 2 diabetes not using insulin.

METHODS:

We performed an incremental cost-effectiveness analysis of the self-monitoring of blood glucose in adults with type 2 diabetes not taking insulin. We used the United Kingdom Prospective Diabetes Study (UKPDS) model to forecast diabetes-related complications, corresponding quality-adjusted life years and costs. Clinical data were obtained from a systematic review comparing self-monitoring with no self-monitoring. Costs and utility decrements were derived from published sources. We performed sensitivity analyses to examine the robustness of the results.

RESULTS:

Based on a clinically modest reduction in hemoglobin A(1C) of 0.25% (95% confidence interval 0.15-0.36) estimated from the systematic review, the UKPDS model predicted that self-monitoring performed 7 or more times per week reduced the lifetime incidence of diabetes-related complications compared with no self-monitoring, albeit at a higher cost (incremental cost per quality-adjusted life year $113,643). The results were largely unchanged in the sensitivity analysis, although the incremental cost per quality-adjusted life year fell within widely cited cost-effectiveness thresholds when testing frequency or the price per test strip was substantially reduced from the current levels.

INTERPRETATION:

For most patients with type 2 diabetes not using insulin, use of blood glucose test strips for frequent self-monitoring (>or= 7 times per week) is unlikely to represent efficient use of finite health care resources, although periodic testing (e.g., 1 or 2 times per week) may be cost-effective. Reduced test strip price would likely also improve cost-effectiveness.

PMID:
20026626
PMCID:
PMC2802601
DOI:
10.1503/cmaj.090765
[Indexed for MEDLINE]
Free PMC Article

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