Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 140 No. 4344 (2010)

Evaluating the cost-effectiveness of self-monitoring of blood glucose in type 2 diabetes patients on oral anti-diabetic agents

  • R Pollock
  • W Valentine
  • G Goodall
  • M Brändle
DOI
https://doi.org/10.4414/smw.2010.13103
Cite this as:
Swiss Med Wkly. 2010;140:w13103
Published
25.10.2010

Summary

OBJECTIVES: To evaluate the cost-effectiveness of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes treated with oral anti-diabetic agents (OADs) in Switzerland.

METHODS: A validated computer model of diabetes was used to project outcomes reported from a published longitudinal study of SMBG in type 2 diabetes patients, treated with OADs and with no history of SMBG, over a 30-year time horizon and cost-effectiveness was assessed from the perspective of a third party healthcare payer. Costs and clinical outcomes were discounted at 3% annually in line with recommended practice. Sensitivity analyses were performed.

RESULTS: Once, twice or three times daily SMBG was associated with improvements in HbA1c which led to increased life expectancy and quality-adjusted life expectancy, and reduced incidence of diabetes complications compared with no SMBG in type 2 diabetes patients on OADs. Direct medical costs increased by CHF 528, CHF 1'650 and CHF 2'899 in patients performing SMBG once, twice or three times daily compared to those not using SMBG, respectively. Incremental cost-effectiveness ratios were well below commonly quoted willingness-to-pay thresholds at CHF 9'177, CHF 12'928 and CHF 17'342 per quality-adjusted life year (QALY) gained respectively.

CONCLUSIONS: Based on data from a large observational study, SMBG is likely to be cost-effective by generally accepted standards in SMBG-naïve patients on oral anti-diabetic agents in the Swiss setting.

References

  1. IDF Diabetes Atlas. Executive Summary. 2009 (last accessed May 31 2010); Fourth Edition. Available from: http://www.diabetesatlas.org/content/executive-summary
  2. Firmann M, Mayor V, Vidal PM, Bochud M, Pécoud A, Hayoz D, Paccaud F, Preisig M, Song KS, Yuan X, Danoff TM, Stirnadel HA, Waterworth D, Mooser V, Waeber G, Vollenweider P. The CoLaus study: a population-based study to investigate the epidemiology and genetic determinants of cardiovascular risk factors and metabolic syndrome. BMC Cardiovasc Disord. 2008;8:6.
  3. Nyomba BL, Berard L, Murphy LJ. Facilitating access to glucometer reagents increases blood glucose self-monitoring frequency and improves glycaemic control: a prospective study in insulin-treated diabetic patients. Diabet Med. 2004;21(2):129–35.
  4. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86.
  5. Karter AJ, Ackerson LM, Darbinian JA, D'Agostino RB Jr, Ferrara A, Liu J, Selby JV. Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes registry. Am J Med. 2001;111(1):1–9.
  6. Nathan DM, McKitrick C, Larkin M, Schaffran R, Singer DE. Glycemic control in diabetes mellitus: have changes in therapy made a difference? Am J Med. 1996;100(2):157–63.
  7. Ipp E, Aquino RL, Christenson P. Point: self-monitoring of blood glucose in type 2 diabetic patients not receiving insulin: the sanguine approach. Diabetes Care 2005;28(6):1528–1530.
  8. Davidson MB. Counterpoint: Self-monitoring of blood glucose in type 2 diabetic patients not receiving insulin: a waste of money. Diabetes Care. 2005;28(6):1531–3.
  9. Mittel- und Gegenstandsliste Bundesamt für Gesundheit (last accessed February 14, 2010). http://www.bag.admin.ch/themen/krankenversicherung/00263/00264/04184/
  10. Fontbonne A, Billault B, Acosta M, Percheron C, Varenne P, Besse A, Eschwege E, Monnier L, Slama G, Passa P. Is glucose self-monitoring beneficial in non-insulin-treated diabetic patients? Results of a randomized comparative trial. Diabete Metab. 1989;15(5):255–60.
  11. Muchmore DB, Springer J, Miller M. Self-monitoring of blood glucose in overweight type 2 diabetic patients. Acta Diabetol. 1994;31(4):215–9.
  12. Allen BT, DeLong ER, Feussner JR. Impact of glucose self-monitoring on non-insulin-treated patients with type II diabetes mellitus. Randomized controlled trial comparing blood and urine testing. Diabetes Care. 1990;13(10):1044–50.
  13. Schwedes U, Siebolds M, Mertes G; SMBG Study Group. Meal-related structured self-monitoring of blood glucose: effect on diabetes control in non-insulin-treated type 2 diabetic patients. Diabetes Care. 2002;25(11):1928–32.
  14. Guerci B, Drouin P, Grangé V, Bougnères P, Fontaine P, Kerlan V, Passa P, Thivolet Ch, Vialettes B, Charbonnel B; ASIA Group. Self-monitoring of blood glucose significantly improves metabolic control in patients with type 2 diabetes mellitus: the Auto-Surveillance Intervention Active (ASIA) study. Diabetes Metab. 2003;29(6):587–94.
  15. Davidson MB, Castellanos M, Kain D, Duran P. The effect of self monitoring of blood glucose concentrations on glycated hemoglobin levels in diabetic patients not taking insulin: a blinded, randomized trial. Am J Med. 2005;118(4):422–5.
  16. O'Kane MJ, Bunting B, Copeland M, Coates VE; ESMON study group. Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomised controlled trial. BMJ. 2008;336(7654):1174–7.
  17. Welschen LM, Bloemendal E, Nijpels G, Dekker JM, Heine RJ, Stalman WA, Bouter LM. Self-monitoring of blood glucose in patients with type 2 diabetes who are not using insulin: a systematic review. Diabetes Care. 2005;28(6):1510–7.
  18. Karter AJ, Parker MM, Moffet HH, Spence MM, Chan J, Ettner SL, Selby JV. Longitudinal study of new and prevalent use of self-monitoring of blood glucose. Diabetes Care. 2006;29(8):1757–63.
  19. Palmer AJ, Roze S, Valentine WJ, Minshall ME, Foos V, Lurati FM, Lammert M, Spinas GA. The CORE Diabetes Model: Projecting long-term clinical outcomes, costs and cost-effectiveness of interventions in diabetes mellitus (types 1 and 2) to support clinical and reimbursement decision-making. Curr Med Res Opin. 2004;20 Suppl 1:S5–26.
  20. Palmer AJ, Roze S, Valentine WJ, Minshall ME, Foos V, Lurati FM, Lammert M, Spinas GA. Validation of the CORE Diabetes Model against epidemiological and clinical studies. Curr Med Res Opin. 2004;20 Suppl 1:S27–40.
  21. Briggs AH, Wonderling DE, Mooney CZ. Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ 1997; 6(4): 327–340.
  22. NICE. National Institute for Health and Clinical Excellence. Guide to the Methods of Technology Appraisal. http://www.nice.org.uk/niceMedia/pdf/TAP_Methods.pdf 2004 (last accessed May 24, 2009).
  23. Saaddine JB, Cadwell B, Gregg EW, Engelgau MM, Vinicor F, Imperatore G, Narayan KM. Improvements in diabetes processes of care and intermediate outcomes: United States, 1988–2002. Ann Intern Med. 2006 ;144(7):465–74.
  24. Harris MI. Health care and health status and outcomes for patients with type 2 diabetes. Diabetes Care. 2000;23(6):754–8.
  25. Clarke PM, Gray AM, Briggs A, Farmer AJ, Fenn P, Stevens RJ, Matthews DR, Stratton IM, Holman RR and UK Prospective Diabetes Study (UKDPS) Group. A model to estimate the lifetime health outcomes of patients with type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68). Diabetologia. 2004;47(10):1747–59.
  26. Brändle M, Erny-Albrecht KM, Goodall G, Spinas GA, Streit P, Valentine WJ. Exenatide versus insulin glargine: A Cost-effectiveness Evaluation in Patients with type 2 diabetes in Switzerland. Int J Clin Pharmacol Ther. 2009;47(8):501–15.
  27. Tarn T, Smith M. Pharmacoeconomic Guidelines Around the World. ISPOR Connections. 2004 10(4): 5–15.
  28. Schmitt-Koopmann I, Schwenkglenks M, Spinas GA, Szucs TD. Direct medical costs of type 2 diabetes and its complications in Switzerland. Eur J Public Health. 2004;14(1):3–9.
  29. Brändle M, Goodall G, Erny-Albrecht KM, Erdmann E, Valentine WJ. Cost-effectiveness of pioglitazone in patients with type 2 diabetes and a history of macrovascular disease in a Swiss setting. Swiss Med Wkly. 2009;139(11–12):173–84.
  30. Farmer A, Wade A, Goyder E, Yudkin P, French D, Craven A, Holman R, Kinmonth AL, Neil A. Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial. BMJ. 2007;335(7611):132.
  31. Coster S, Gulliford MC, Seed PT, Powrie JK, Swaminathan R. Self-monitoring in Type 2 diabetes mellitus: a meta-analysis. Diabet Med. 2000;17(11):755–61.
  32. Sarol JN Jr, Nicodemus NA Jr, Tan KM, Grava MB. Self-monitoring of blood glucose as part of a multi-component therapy among non-insulin requiring type 2 diabetes patients: a meta-analysis (1966–2004). Curr Med Res Opin. 2005;21(2):173–84.
  33. Jansen JP. Self-monitoring of glucose in type 2 diabetes mellitus: a Bayesian meta-analysis of direct and indirect comparisons. Curr Med Res Opin. 2006;22(4):671–81.
  34. Towfigh A, Romanova M, Weinreb JE, Munjas B, Suttorp MJ, Zhou A, Shekelle PG. Self-monitoring of blood glucose levels in patients with type 2 diabetes mellitus not taking insulin: a meta-analysis. Am J Manag Care. 2008;14(7):468–75.
  35. St John A, Davis WA, Price CP, Davis TM. The value of self-monitoring of blood glucose: a review of recent evidence. J Diabetes Complications. 2010 ;24(2):129–41.
  36. Allemann S, Houriet C, Diem P, Stettler C. Self-monitoring of blood glucose in non-insulin treated patients with type 2 diabetes: a systematic review and meta-analysis. Curr Med Res Opin. 2009;25(12):2903–13.
  37. Muchmore DB, Springer J, Miller M. Self-monitoring of blood glucose in overweight type 2 diabetic patients. Acta Diabetol. 1994;31:215–219.
  38. Schwedes U, Siebolds M, Mertes G. Meal-related structured self-monitoring of blood glucose: effect on diabetes control in non-insulin-treated type 2 diabetic patients. Diabetes Care. 2002;25:1928–32.
  39. Franciosi M, Pellegrini F, De Berardis G, Belfiglio M, Cavaliere D, Di Nardo B, Greenfield S, Kaplan SH, Sacco M, Tognoni G, Valentini M, Nicolucci A; QuED Study Group. The impact of blood glucose self-monitoring on metabolic control and quality of life in type 2 diabetic patients: an urgent need for better educational strategies. Diabetes Care. 2001;24(11):1870–7.