Cost effectiveness of self monitoring of blood glucose in patients with non-insulin treated type 2 diabetes: economic evaluation of data from the DiGEM trial

doi:10.1136/bmj.39526.674873.BE

BMJ, doi: 10.1136/bmj.39526.674873.BE, (Published 17 April 2008)

Research

Cost effectiveness of self monitoring of blood glucose in patients with non-insulin treated type 2 diabetes: economic evaluation of data from the DiGEM trial

Judit Simon, senior researcher¹, Alastair Gray, professor¹, Philip Clarke, senior international research fellow², Alisha Wade, resident³, Andrew Neil, professor⁴, Andrew Farmer, lecturer⁵, on behalf of the Diabetes Glycaemic Education and Monitoring Trial Group

¹ Health Economics Research Centre, Department of Public Health, University of Oxford, Oxford OX3 7LF, ² School of Public Health, University of Sydney, Australia, ³ Johns Hopkins School of Medicine, Baltimore, MD, USA, ⁴ Division of Public Health and Primary Health Care, University of Oxford, ⁵ Department of Primary Health Care, University of Oxford

Correspondence to: J Simon judit.simon{at}dphpc.ox.ac.uk

Objective To assess the cost effectiveness of self monitoringof blood glucose alone or with additional training in incorporatingthe results into self care, in addition to standardised usualcare for patients with non-insulin treated type 2 diabetes.

Design Incremental cost utility analysis from a healthcare perspective.Data on resource use from the randomised controlled diabetesglycaemic education and monitoring (DiGEM) trial covered 12months before baseline and 12 months of trial follow-up. Qualityof life was measured at baseline and 12 months using the EuroQolEQ-5D questionnaire.

Setting Primary care in the United Kingdom.

Participants 453 patients with non-insulin treated type 2 diabetes.

Interventions Standardised usual care (control) compared withadditional self monitoring of blood glucose alone (less intensiveself monitoring) or with training in self interpretation ofthe results (more intensive self monitoring).

Main outcome measures Quality adjusted life years and healthcarecosts (sterling in 2005-6 prices).

Results The average costs of intervention were £89 ( ${euro}$ 113;$179) for standardised usual care, £181 for less intensiveself monitoring, and £173 for more intensive self monitoring,showing an additional cost per patient of £92 (95% confidenceinterval £80 to £103) in the less intensive groupand £84 (£73 to £96) in the more intensivegroup. No other significant cost difference was detected betweenthe groups. An initial negative impact of self monitoring onquality of life occurred, averaging –0.027 (95% confidenceinterval–0.069 to 0.015) for the less intensive self monitoringgroup and –0.075 (–0.119 to –0.031) for themore intensive group.

Conclusions Self monitoring of blood glucose with or withoutadditional training in incorporating the results into self carewas associated with higher costs and lower quality of life inpatients with non-insulin treated type 2 diabetes. In lightof this, and no clinically significant differences in otheroutcomes, self monitoring of blood glucose is unlikely to becost effective in addition to standardised usual care.

Trial registration Current Controlled Trials ISRCTN47464659 [controlled-trials.com] .

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