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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

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39526.674873.BE (Published 22 May 2008) Cite this as: BMJ 2008;336:1177
  1. Judit Simon, senior researcher1,
  2. Alastair Gray, professor1,
  3. Philip Clarke, senior international research fellow2,
  4. Alisha Wade, resident3,
  5. Andrew Neil, professor4,
  6. Andrew Farmer, lecturer5
  7. on behalf of the Diabetes Glycaemic Education and Monitoring Trial Group
  1. 1Health Economics Research Centre, Department of Public Health, University of Oxford, Oxford OX3 7LF
  2. 2School of Public Health, University of Sydney, Australia
  3. 3Johns Hopkins School of Medicine, Baltimore, MD, USA
  4. 4Division of Public Health and Primary Health Care, University of Oxford
  5. 5Department of Primary Health Care, University of Oxford
  1. Correspondence to: J Simon judit.simon{at}dphpc.ox.ac.uk
  • Accepted 14 March 2008

Abstract

Objective To assess the cost effectiveness of self monitoring of blood glucose alone or with additional training in incorporating the results into self care, in addition to standardised usual care 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 diabetes glycaemic education and monitoring (DiGEM) trial covered 12 months before baseline and 12 months of trial follow-up. Quality of life was measured at baseline and 12 months using the EuroQol EQ-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 with additional self monitoring of blood glucose alone (less intensive self monitoring) or with training in self interpretation of the results (more intensive self monitoring).

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

Results The average costs of intervention were £89 (€113; $179) for standardised usual care, £181 for less intensive self monitoring, and £173 for more intensive self monitoring, showing an additional cost per patient of £92 (95% confidence interval £80 to £103) in the less intensive group and £84 (£73 to £96) in the more intensive group. No other significant cost difference was detected between the groups. An initial negative impact of self monitoring on quality of life occurred, averaging −0.027 (95% confidence interval−0.069 to 0.015) for the less intensive self monitoring group and −0.075 (−0.119 to −0.031) for the more intensive group.

Conclusions Self monitoring of blood glucose with or without additional training in incorporating the results into self care was associated with higher costs and lower quality of life in patients with non-insulin treated type 2 diabetes. In light of this, and no clinically significant differences in other outcomes, self monitoring of blood glucose is unlikely to be cost effective in addition to standardised usual care.

Trial registration Current Controlled Trials ISRCTN47464659.

Footnotes

  • We thank the participants in the diabetes glycaemic education and monitoring trial and their general practitioners for support and help.

  • Contributors: AG, AN, and AF had the original idea for the economic evaluation. AF and AW managed the trial. JS and AG developed the economic analysis plan and carried out the evaluation. PC contributed to the extrapolation beyond the trial. JS wrote the first draft of the manuscript with AG and AF. All coauthors reviewed and commented on the final manuscript. JS is the guarantor of this paper. Members of the DiGEM Trial Group are as follows—writing committee: JS, AG, PC, AW, AN, and AF; investigators: AF, AG, AN, D French, R Holman, A-L Kinmonth, D Mant, S Ziebland, and P Yudkin; steering committee: N Stott (chair), AF, AN (to 2005), S Sutton, H Tewson, D Chapman, H Hearnshaw, E Goyder (from 2005), P Glasziou (from 2005), M Jiwa (2004 to 2005), and M Gordon (from 2005); intervention development: AW, AF, D French, A-L Kinmonth, and MP Selwood; coordinating centres: (Oxford) AW (to 2005, trial coordinator), JS (health economist), A Craven (trial manager), P Yudkin (trial statistician), and A Fuller (data manager); and (Sheffield) V Walker (local trial administrator); data monitoring committee: C Baigent (chair), J Levy, and K Wheatley; research nurses (Oxford) MP Selwood, H Kirlow, M Chapman, and S Turner; (Sheffield) A Casbolt, K Dobson, A Willert, A Roberts, and H Wood; and central laboratory: K Islam.

  • Funding: The diabetes glycaemic education and monitoring trial was funded by the UK NHS and the NHS health technology assessment programme. The opinions expressed in this report are not necessarily those of the Department of Health. JS was supported by an NHS research and development research scientist award. AF was supported by an NHS research and development career development award from 2001-5. The Department of Primary Health Care, University of Oxford is a partner in the National Institute for Health Research School of Primary Care Research.

  • Competing interests: AG has been reimbursed by Eli Lily for attending several advisory meetings.

  • Ethical approval: The diabetes glycaemic education and monitoring study was approved by the Oxfordshire Research Ethics Committee B (002.059).

  • Accepted 14 March 2008
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