CGM may lead to lower health care costs for pregnant women with type 1 diabetes
Key takeaways:
- In a real-world analysis, the cost of CGM use during a type 1 diabetes pregnancy was less than self-monitoring blood glucose.
- The cost savings were tied to a lower rate of neonatal ICU admissions with CGM.
The use of a continuous glucose monitor during pregnancy may be more cost-effective than self-monitoring blood glucose for women with type 1 diabetes, according to a brief report published in Diabetes Technology & Therapeutics.
Researchers conducted two analyses to compare the cost of CGM use during a type 1 diabetes pregnancy with SMBG using finger sticks alone. In a base-case analysis in which researchers assumed all women would use seven finger sticks per day as dictated by the American Diabetes Association’s guidelines for diabetes management in pregnancy, CGM had a higher per-person cost than SMBG. However, in a real-world analysis in which women with a CGM used three finger sticks per day and those performing SMBG used five finger sticks daily, CGM was more cost-effective.
“CGM devices can be costly, but a pregnancy with adverse pregnancy outcomes is as well,” Sarit Polsky, MD, MPH, associate professor of medicine and pediatrics in the adult clinic of the Barbara Davis Center for Diabetes at University of Colorado Anschutz Medical Campus, told Healio. “Thus, examining if the cost of CGM devices is offset by improved pregnancy outcomes is important.”
Polsky and colleagues determined CGM use frequency, neonatal ICU admission rates and mean gestation from the Triple C study, a retrospective study comparing health outcomes for pregnant women with type 1 diabetes using CGM vs. SMBG. The Triple C study findings, which were published in Diabetes Technology & Therapeutics in 2024, found 52.9% of infants of mothers using CGM required a neonatal ICU admission compared with 68.3% of mothers performing SMBG. The costs of CGM and finger sticks, and per-patient costs of a level II neonatal ICU admission were obtained from multiple literature sources. Costs were adjusted to 2023 U.S. dollars.
In the base-case analysis, CGM use during pregnancy cost $16,254 per person compared with $15,182 for SMBG. In the real-world analysis, SMBG was more expensive with a per-person cost of $14,524 compared with $13,708 with CGM use.
In the real-world analysis, CGM users had a per-person cost of $2,747 for the CGM, $988 for finger sticks and $9,973 for neonatal ICU admissions. For SMBG, finger sticks cost $1,647 and neonatal ICU admission costs were $12,876. The reduction in neonatal ICU admission rates with CGM use led to a mean cost savings of $2,903 in the real-world analysis.
In a probabilistic sensitivity analysis, CGM was more cost-effective than SMBG in 46% of Monte Carlo simulation models.
“These findings justify paying for CGM devices in type 1 diabetes pregnancies, even in the U.S., which has an expensive health care system,” Polsky said in an interview. “CGM use improves neonatal health outcomes in this population and has been shown to be cost-neutral or cost-saving in the U.K., Canada and the U.S.”
Polsky said future research should focus on the cost-effectiveness of automated insulin delivery systems in pregnancy.
“Automated insulin delivery use has been shown to improve glycemic outcomes in type 1 diabetes pregnancies, but it is still unclear if it improves maternal or neonatal health outcomes and if it would be cost-beneficial,” Polsky said.
Reference:
Gao V, et al. Diabetes Technol Ther. 2024;doi:10.1089/dia.2023.0548.
For more information:
Sarit Polsky, MD, MPH, can be reached at sarit.polsky@cuanschutz.edu.
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