Canadian Medical Association Journal

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

¹ The Canadian Optimal Medication Prescribing and Utilization Service, Canadian Agency for Drugs and Technologies in Health, Ottawa, Ont.
² The Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont.
³ The Division of Endocrinology, St. Paul's Hospital and Vancouver General Hospital, University of British Columbia, Vancouver, BC; the Canadian Optimal Medication Prescribing and Utilization Service Expert Review Committee
⁴ The Department of Medicine, University of Alberta, Calgary, Alta; and the Canadian Optimal Medication Prescribing and Utilization Service Expert Review Committee

	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 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 costeffective. Reduced test strip price would likely also improve cost-effectiveness.