Continuous Glucose Monitoring Original Research An Economic Evaluation of Continuous Glucose Monitoring for People with Type 1 Diabetes and Impaired Awareness of Hypoglycaemia within North West London Clinical Commissioning Groups in England Shraddha Chaugule, 1 Nick Oliver, 2 Brigitte Klinkenbijl 3 and Claudia Graham 1 1. Global Access, Dexcom Inc., San Diego, CA, US; 2. Section of Diabetes, Endocrinology and Metabolism, Faculty of Medicine, Imperial College, London, UK; 3. International Access, Dexcom Operating Limited, Tanfield, Edinburgh, Scotland, UK O bjective: To assess the economic impact of providing real time continuous glucose monitoring (CGM) for people with type 1 diabetes (T1D) and impaired awareness of hypoglycaemia (IAH) within North West (NW) London clinical commissioning groups (CCGs). Methods: The eligible population for CGM and inputs for the economic budget impact model developed were derived from published data. The model includes cost of CGM; cost savings associated with lower hypoglycaemia related hospital admissions, accidents and emergency visits; self-monitoring of blood glucose (SMBG) strip usage; and glycated haemoglobin (HbA1c) reduction-related avoided complications and insulin pump use. Results: The cost of CGM for T1D-IAH (n=3,036) in the first year is £10,770,671 and in the fourth year is £11,329,095. The combined cost off-sets related to reduced hypoglycaemia admissions, SMBG strip usage and complications are £8,116,912 and £8,741,026 in years one and four, respectively. The net budget impact within the NW London CCGs is £2,653,760; £2,588,068 in years one and four respectively. Conclusions: Introduction of CGM for T1D-IAH patients will have a minimal budget impact on NW London CCGs, driven by cost of CGM and offsets from lower hypoglycaemia-related costs, reduced SMBG strip usage, avoided HbA1c-related complications and lower insulin pump use. Keywords Continuous glucose monitoring, economics, type 1 diabetes, clinical commissioning group Disclosure: Shraddha Chaugule is an employee of Dexcom, Inc. Brigitte Klinkenbijl is an employee of Dexcom, Inc. and owns stock in the company. Claudia Graham is an employee of Dexcom, Inc. and owns stock in the company. Nick Oliver has nothing to declare in relation to this article. Acknowledgments: The authors would like to thank Dr Mark Charney for help with the initial model conceptualisation and Dr John Welsh for editorial assistance. Compliance with Ethics: This study involves an economic evaluation and did not involve any studies with human or animal subjects performed by any of the authors. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 11 July 2017 Accepted: 11 August 2017 Citation: European Endocrinology, 2017;13(2):81–5 Corresponding Author: Brigitte Klinkenbijl, International Access, Dexcom Operating Limited, Tanfield, Edinburgh, EH3 5DA, Scotland, UK. E: bklinkenbijl@dexcom.com Support: The publication of this article was supported by Dexcom, Inc. The views and opinions expressed are those of the authors and do not necessarily reflect those of Dexcom, Inc. TOU CH MED ICA L MEDIA About 10% of adults with diabetes in the United Kingdom (UK) have type 1 diabetes (T1D) and are treated by daily insulin doses – taken either by injections or via an insulin pump. 1 Diabetes is a leading cause of morbidity and mortality and is associated with substantial healthcare and societal costs. The cost of diabetes to the National Health Service (NHS) is over £1.5m an hour or 10% of the total NHS budget for England and Wales. This equates to over £25,000 being spent on diabetes every minute. 2 Intensive therapy that lowers average glucose levels has been shown to reduce the risk of the long-term complications of diabetes but it also increases the risk of hypoglycaemia, 3–5 which results in significant morbidity and mortality and may cause fear of hypoglycaemia which is a major barrier to optimising glucose control. 2 Real-time continuous glucose monitoring (CGM) is the most advanced glucose monitoring technology that continuously measures interstitial glucose levels, displays the current glucose level and direction and rate of change, and uses alarms and alerts to inform patients and caregivers when glucose levels are exceeding or falling below specified thresholds. 6,7 This complete picture of glycaemic activity helps guide diabetes management decisions (e.g., insulin dosage adjustments, changes in diet) to avoid glycaemic excursions. 6,7 In the recently conducted DIAMOND randomised controlled trial (RCT) in T1D participants on multiple daily injections (MDI) with a mean baseline glycated haemoglobin (HbA1c) of 70 mmol/mol (8.6%), there was a 10.9 mmol/mol (1%) demonstrated reduction in HbA1c for the CGM group compared with 4.4 mmol/mol (0.4%) reduction in the self-monitoring of blood glucose (SMBG) group at 24 weeks from baseline. Participants in the CGM group also spent significantly less time (p=0.002) in hypoglycaemia (duration of hypoglycaemia) at <2.8 mmol/L, <3.3 mmol/L and <3.9 mmol/L; had a significant reduction in diabetes distress (p<0.001); less fear of hypoglycaemia (p=0.02); and an increase in hypoglycaemia confidence (p<0.001) and well-being (p=0.01), compared with conventionally monitored patients using SMBG alone. 8,9 Similarly, in the GOLD RCT, T1D participants on MDI and HbA1c above target, a significant reduction in HbA1c was seen using CGM compared with SMBG alone. 10 Recurrent hypoglycaemia induces a maladaptive response that impairs the ability of patients to detect the early warning signs of hypoglycaemia, a condition known as impaired awareness of hypoglycaemia (IAH). IAH significantly increases the risk of severe hypoglycaemia, which requires assistance from a third party to treat 11 and often requires costly emergency medical care. 12 Tools are needed that can help people with insulin-treated diabetes to lower their blood glucose levels 81