DOI: 10.6084/m9.figshare.30196786
title: Supplementary materials: 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

description: <b>These are peer-reviewed supplementary materials for the article</b><b> </b><b>'</b><b>The cost-effectiveness of real-time </b><b>continuous glucose monitoring versus </b><b>intermittently scanned continuous glucose </b><b>monitoring in individuals with </b><b>insulin-treated Type 2 diabetes mellitus in </b><b>Canada</b><b>'</b><b> </b><b>published in the</b><b> </b><b><i>Journal of Comparative Effectiveness Research</i></b><b>.</b><br><b>Appendix 1:</b> ECHO-T2DM Description<b>Supplementary figure 1: </b>ECHO-T2DM simplified flow diagram<b>Appendix 2: </b>Validation of ECHO-T2DM<b>Appendix Table 1: </b>ECHO-T2DM Cross-Validation Results=<b>Appendix Table 1:</b> ECHO-T2DM Cross-Validation Results<b>Appendix Table </b><b>2</b><b>: </b>ECHO-T2DM External Validation<b>ECHO-T2DM AdViSHE Assessment</b><b>Part B: </b>Input Data Validation<b>Part C:</b> Validation of the Computerized Model<b>Part D: </b>Operational Validation<b>Part E: </b>Other Validation Techniques<b>Appendix 3:</b> Detailed Input Data<b>Appendix Table 3: </b>Comparison of DIAMOND T2D and REPLACE<b>Appendix Table 4:</b> Unit Costs for Micro- and Macrovascular Complications (Inflated to 2023 CAD)<b>Appendix Table 5: </b>QALY Disutility Weights<b>Appendix 4:</b> Detailed Results<b>Appendix Table 6:</b> Rates for First Event (Per 100 Patient-Years)<b>Appendix Table 7:</b> Base Case Sources of QALY Disutility<b>Appendix Table 8:</b> Results of Sensitivity Analysis Comparing rtCGM with isCGM in patients with T2DM<b>Appendix Figure 2:</b> Estimated HbA1c Trajectory<b>Appendix Figure 3:</b> Estimated Survival<b>Appendix Figure 4: </b>Model Convergence<b>Appendix 5:</b> Checklist of Reporting Model Input in Diabetes Health Economics Studies and CHEERS Checklist<b>References</b><b>Consolidated Health Economic Evaluation Reporting Standard (CHEERS) 2022 Checklist</b><b>Aim:</b> 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. <b>Materials </b><b>& methods: </b>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. <b>Results: </b>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. <b>Discussion:</b> 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. <b>Conclusion:</b> Rt-CGM is a potentially cost-saving option for managing insulin-treated T2DM in Canada, with implications for clinical practice and reimbursement policy.