Fewer hospitalizations, but higher total health costs 1 year after CGM initiation
People with type 1 diabetes in Israel had fewer hospitalizations with high adherence to continuous glucose monitoring 1 year after starting to use the device, but also experienced higher total health costs, according to study data.
“This real-world study shows that CGM system technologies can reduce [ED] visits and hospitalizations, thus reducing diabetes short-term consequences, and may impact long-term complications,” Joseph Azuri, MD, MHA, a senior lecturer in the Sackler Faculty of Medicine at Tel Aviv University, and colleagues wrote in a study published in Diabetic Medicine. “However, CGM system technologies are costly and, at current prices, put a significant burden on health care systems.”
Researchers conducted a retrospective study of people with type 1 diabetes registered with the Maccabi Healthcare Services in Israel who had diabetes for at least 1 year and were first preauthorized for a CGM between 2011 to 2015. Medical records for each person from the year before and the year after preauthorization were compared. Researchers analyzed HbA1c testing and outcomes, medical services use and total medical costs, which included the costs of medications, CGM supplies, and hospital and ED visits.
Adherence was defined by amount of CGM supplies purchased monthly by each person. Those purchasing five or fewer supplies monthly were categorized as low adherence, six to nine monthly purchases defined moderate adherence, and 10 to 12 monthly purchases was considered high adherence.
There were 524 patients with type 1 diabetes included in the analysis (57% male), with 77% younger than 18 years. Of the study cohort, 35% were in the low adherence group, 22% had moderate adherence and 43% were in the high adherence group. Adherence improved with age, with 37% of those younger than 18 years in the high adherence group, whereas 61% of adults aged 18 years and older had high adherence.
The proportion of people who had HbA1c testing before and after CGM preauthorization was 60% in the low adherence group, lower than the 73% in the moderate adherence group and 75% in high adherence group. There were no significant changes in HbA1c for any of the three groups from before CGM use compared with after.
None of the adherence groups had significant changes in the number of primary care or diabetes clinic visits. Before CGM preauthorization 30% of the study population had an ED visit, which decreased to 19% in the year after (P < .01). The low adherence group had a 4.5% decrease in ED visits after initiating CGM; the decrease 9.5% for those with moderate adherence and 15% for those with high adherence. There was also a decrease in hospitalizations in the study population from 22% before CGM use to 12% after (P < .01) — an 11% decrease for the high adherence group and nonsignificant decreases for the other groups.
Total health costs per person increased for all three adherence groups with CGM use —. 80% for those with high adherence, 72.5% with moderate adherence and 16.63% with low adherence. All three groups had decreases in hospital costs after CGM preauthorization.
“[The total cost increase] is mainly due to the CGM system and consumable equipment costs,” the researchers wrote. “It is reasonable to believe that following the decrease in hospital costs, the total costs are expected to decrease in the following years. Further studies with longer follow-ups are needed to address this question.”
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