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
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: 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. Materials & methods: We used the ECHO-T2DM microsimulation model to estimate incremental lifetime health outcomes and costs of rt-CGM versus is-CGM. Clinical inputs came from an indirect treatment comparison; cost and utility data were drawn from published sources. Sensitivity analyses tested robustness. Results: Rt-CGM was more effective and less costly than is-CGM, yielding 0.346 additional quality-adjusted life-years and CAD 2237 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 3867 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. Discussion: 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. Conclusion: Rt-CGM is a potentially cost-saving option for managing insulin-treated T2DM in Canada, with implications for clinical practice and reimbursement policy.
Plain language summary
What is the article about?
Real-time continuous glucose monitoring (rt-CGM) may help people with Type 2 diabetes mellitus (T2DM) manage their blood sugar more effectively than intermittently scanned CGM (is-CGM). Rt-CGM can reduce episodes of dangerously low or high blood sugar and lower the risk of long-term complications. The two CGM systems differ in terms of user experience, use of alerts and alarms, and acquisition costs per sensor. This study examined the long-term cost-effectiveness of the rt-CGM system versus is-CGM in insulin-treated individuals with T2DM.
What were the results?
Our analysis showed that, over 30 years, using rt-CGM instead of is-CGM can both save money and improve health. The higher device acquisition cost was more than offset by savings associated with avoiding costly health complications. Of our 18 sensitivity tests, 14 supported this result. Even in the four less favorable scenarios, rt-CGM still offered good value compared with the commonly accepted cost threshold of CAD 50,000 per quality-adjusted life-year in Canada.
What do the results mean?
The findings suggest that rt-CGM could be a cost-saving option for managing insulin-treated T2DM in Canada. The benefits of rt-CGM – better blood sugar control, fewer episodes of dangerous blood sugar levels and reduced risk for serious complications like blindness, amputation, and heart disease – outweighed the higher initial acquisition cost. However, these results should be interpreted with caution due to limitations like the lack of head-to-head trials and reliance on model assumptions. More research – especially direct comparisons between rt-CGM and is-CGM – is needed to help confirm and strengthen these findings.
Supplementary Material
References
Papers of special note have been highlighted as: • of interest; •• of considerable interest
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Received: 4 August 2025
Accepted: 10 September 2025
Published online: 24 September 2025
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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. (2025) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2025-0125
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