The cost-effectiveness of real-time continuous glucose monitoring versus intermittently scanned continuous glucose monitoring in individuals with insulin-treated Type 2 diabetes mellitus in Canada

Willis M, Nilsson A, Alshannaq H, Matuoka J, Norman G.

Continuous glucose monitoring (CGM) supports glycemic control and reduces diabetes complications. CGM systems include intermittently scanned CGM (is-CGM) and real-time CGM (rt-CGM). While rt-CGM may provide better outcomes than is-CGM, it costs more upfront and its cost-effectiveness in Canada has not been established. We assessed the cost-effectiveness of rt-CGM versus is-CGM in people with insulin-treated type 2 diabetes mellitus (T2DM) from a Canadian healthcare payer perspective.

We used the ECHO-T2DM microsimulation model to estimate incremental lifetime health outcomes and costs of rt-CGM vs. is-CGM. Clinical inputs came from an indirect treatment comparison; cost and utility data were drawn from published sources. Sensitivity analyses tested robustness.

Rt-CGM was more effective and less costly than is-CGM, yielding 0.346 additional QALYs and CAD 2,237 in savings over 30 years. Benefits stemmed primarily from better glycemic control and fewer complications, reductions in glycemic events, and reduced fear of hypoglycemia. Although rt-CGM incurred CAD 3,867 higher acquisition costs, these were more than offset by avoided complications. Deterministic analysis showed dominance in 14 of 18 scenarios, and cost-effectiveness in the remaining four. Uncertainty analysis showed rt-CGM had an ICER below CAD 50,000 in 98% of simulations.

Rt-CGM is potentially a cost-saving alternative to is-CGM among people with insulin-treated T2DM in Canada. This finding was strengthened by rigorous sensitivity analysis. Study strengths include use of a validated microsimulation model and adoption of conservative assumptions. Limitations include absence of head-to-head trial evidence and indirect use of time in and out of range.

Rt-CGM is a potentially cost-saving option for managing insulin-treated T2DM in Canada, with implications for clinical practice and reimbursement policy.

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Journal of Comparative Effectiveness Research, 2025: p. e250125
DOI: 10.57264/cer-2025-0125