Cost Analysis of the FreeStyle Libre Systems in People with Type 2 Diabetes Mellitus on Basal Insulin with Poor Glycemic Control: A Spanish Perspective

Abstract

Background and Aims: FreeStyle Libre® systems are effective and convenient glucose flash monitoring (FM) devices. This cost analysis compared FM versus self-monitoring of blood glucose (SMBG) in poorly controlled (glycated hemoglobin [HbA1c] >8%) patients with type 2 diabetes (T2D) on basal insulin in Spain. Methods: A model was used to compare the costs of FM and SMBG in a 1000-patient cohort. All model inputs were sourced from scientific literature and validated by a multidisciplinary experts' group. Unitary costs were included in euros (2025), including value-added tax (VAT). The daily use of 2.5 strips (?0.57/strip) and 2.5 lancets (?0.14/lancet) was considered for SMBG according to Spanish recommendations. The events/person-year was 2.5 for severe hypoglycemic events (SHEs) (?1403.03/event), 17.02 for non-SHEs (NSHEs) (?3.92/event), and 0.0025 for diabetic ketoacidosis (DKA) (?2523.93/event). FM reduced the use of strips/lancets (-83.0%; sensor: ?3.00/day) and acute events (NSHEs/SHEs: -58.0%; DKA: -68.0%). Sensitivity analyses were conducted to test robustness. Two additional scenarios were studied, including chronic diabetic complications (absolute reduction in HbA1c with FM: -1.1%) and absenteeism-related costs (reduction in absenteeism with FM: -58.4%). Results: The annual cost per patient was ?3299.99 with SMBG and ?2320.20 with FM. In 1000 patients, FM averted 2162 NSHEs (FM vs. SMBG: -?66,672), 1450 SHEs (FM vs. SMBG: -?2,579,224), and 1.5 DKA (FM vs. SMBG: -?6310), producing total cost savings of ?979.706 compared with SMBG. All sensitivity analyses confirmed cost savings of FM versus SMBG, even when strips/lancets were free (-?442,117) or assuming a lower SHE frequency (1.4 events/patient-year; -?321,488). In 1000 patients, when considering chronic diabetic complications (SMBG: ?3,745,869; FM: ?2,886,785) and absenteeism (SMBG: ?237,990; FM: ?99,004), the annual cost savings of FM versus SMBG rose to ?1,997,777. Conclusions: FreeStyle Libre could reduce acute events, chronic diabetic complications, and work absenteeism in poorly controlled patients with T2D on basal insulin, generating cost savings for the Spanish health system and society.