CMAJ • January 12, 2010; 182 (1). First published December 21, 2009; doi:10.1503/cmaj.090765
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Research

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

Chris Cameron, MSc, Doug Coyle, MSc PhD, Ehud Ur, MD and Scott Klarenbach, MD MSc

From the Canadian Optimal Medication Prescribing and Utilization Service (Cameron), Canadian Agency for Drugs and Technologies in Health, Ottawa, Ont., the Department of Epidemiology and Community Medicine (Coyle), University of Ottawa, Ottawa, Ont., the Division of Endocrinology (Ur), St. Paul’s Hospital and Vancouver General Hospital, University of British Columbia, Vancouver, BC; the Department of Medicine (Klarenbach), University of Alberta, Calgary, Alta; and the Canadian Optimal Medication Prescribing and Utilization Service Expert Review Committee (Ur, Klarenbach).

Correspondence to: Mr. Chris Cameron, Health Economist, Canadian Optimal Medication Prescribing and Utilization Service (COMPUS), Canadian Agency for Drugs and Technologies in Health (CADTH), 600-865 Carling Ave., Ottawa ON K1S 5S8; chrisc{at}cadth.ca

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 A1C 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 (≥ 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.


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Missing the boat
Elie Sarraf
CMAJ, 14 Jan 2010 [Full text]
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Chris Cameron
CMAJ, 21 Jan 2010 [Full text]