Elliott, Rachel ARogers, GabrielEvans, Mark LNeupane, SankalpaRayman, GerryLumley, SarahCranston, IainNarendran, ParthSutton, Christopher JTaxiarchi, Vicky PBurns, MatthewThabit, HoodWilmot, Emma GLeelarathna, Lalantha2023-10-112023-10-112023-09-26Elliott RA, Rogers G, Evans ML, Neupane S, Rayman G, Lumley S, Cranston I, Narendran P, Sutton CJ, Taxiarchi VP, Burns M, Thabit H, Wilmot EG, Leelarathna L; FLASH-UK Trial Study Group. Estimating the cost-effectiveness of intermittently scanned continuous glucose monitoring in adults with type 1 diabetes in England. Diabet Med. 2024 Mar;41(3):e15232. doi: 10.1111/dme.15232.0742-30711464-549110.1111/dme.1523237750427http://hdl.handle.net/20.500.14200/2514Objective: We previously showed that intermittently scanned continuous glucose monitoring (isCGM) reduces HbA1c at 24 weeks compared with self-monitoring of blood glucose with finger pricking (SMBG) in adults with type 1 diabetes and high HbA1c levels (58-97 mmol/mol [7.5%-11%]). We aim to assess the economic impact of isCGM compared with SMBG. Methods: Participant-level baseline and follow-up health status (EQ-5D-5L) and within-trial healthcare resource-use data were collected. Quality-adjusted life-years (QALYs) were derived at 24 weeks, adjusting for baseline EQ-5D-5L. Participant-level costs were generated. Using the IQVIA CORE Diabetes Model, economic analysis was performed from the National Health Service perspective over a lifetime horizon, discounted at 3.5%. Results: Within-trial EQ-5D-5L showed non-significant adjusted incremental QALY gain of 0.006 (95% CI: -0.007 to 0.019) for isCGM compared with SMBG and an adjusted cost increase of £548 (95% CI: 381-714) per participant. The lifetime projected incremental cost (95% CI) of isCGM was £1954 (-5108 to 8904) with an incremental QALY (95% CI) gain of 0.436 (0.195-0.652) resulting in an incremental cost-per-QALY of £4477. In all subgroups, isCGM had an incremental cost-per-QALY better than £20,000 compared with SMBG; for people with baseline HbA1c >75 mmol/mol (9.0%), it was cost-saving. Sensitivity analysis suggested that isCGM remains cost-effective if its effectiveness lasts for at least 7 years. Conclusion: While isCGM is associated with increased short-term costs, compared with SMBG, its benefits in lowering HbA1c will lead to sufficient long-term health-gains and cost-savings to justify costs, so long as the effect lasts into the medium term.en© 2023 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.EndocrinologyArticle