Evaluating the cost-effectiveness of real-time continuous glucose monitoring versus self-monitoring of blood glucose in the treatment of patients with insulin-treated type 2 diabetes in Australia

Introduction: Type 2 diabetes (T2D) is a major public health concern in Australia, associated with substantial clinical, humanistic, and economic burden. The condition is linked to high rates of cardiovascular and microvascular complications, premature mortality, and reduced quality of life. Effective glycemic management is central to reducing these adverse outcomes. Real-time continuous glucose monitoring (RT-CGM) has been shown to improve glycemic control in insulin-treated T2D compared with self-monitoring of blood glucose (SMBG). However, evidence of its cost-effectiveness in the Australian setting is limited. This study aimed to evaluate the cost-effectiveness of Dexcom ONE+ RT-CGM versus SMBG in adults with insulin-treated T2D in Australia. Methods: A lifetime economic evaluation was conducted using version 10 of the IQVIA CORE Diabetes Model. The analysis simulated clinical and economic outcomes for two subgroups: those on intensive insulin therapy (IIT) and non-intensive insulin therapy (NIIT). Treatment effects were sourced from clinical trials and real-world evidence. Outcomes included life years, quality-adjusted life years (QALYs), and direct healthcare costs. Incremental cost-effectiveness ratios (ICERs) were calculated as cost per QALY gained. Scenario and sensitivity analyses tested robustness. Results: RT-CGM was dominant compared to SMBG in both IIT and NIIT subgroups. In IIT, RT-CGM yielded 0.567 additional QALYs and cost savings of AUD 9869. In NIIT, it yielded 0.319 additional QALYs and savings of AUD 5253. Results were robust across sensitivity analyses. Health equity considerations were also identified, particularly for Indigenous populations and those with youth-onset T2D. Conclusions: RT-CGM was dominant in both insulin-treated subgroups, improving patient outcomes while reducing healthcare costs. These findings highlight the potential value of RT-CGM for broad reimbursement in Australia and the importance of addressing inequities in glycemic management, particularly among Indigenous Australians and younger individuals with T2D.