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A Framework for Integrating Continuous Glucose Monitor-Derived Metrics into Economic Evaluations in Type 1 Diabetes

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Abstract

Economic models in type 1 diabetes have relied on a change in haemoglobin A1c as the link between the blood glucose trajectory and long-term clinical outcomes, including microvascular and macrovascular disease. The landscape has changed in the past decade with the availability of regulatory approved, accurate and convenient continuous glucose monitoring devices and their ability to track patients’ glucose levels over time. The data emerging from continuous glucose monitoring have enriched the clinical understanding of the disease and indirectly of patients’ behaviour. This has triggered the development of new measures proposed to better define the quality of glycaemic control, beyond haemoglobin A1c. The objective of this paper is to review recent developments in clinical knowledge brought into focus with the application of continuous glucose monitoring devices, and to discuss potential approaches to incorporate the concepts into economic models in type 1 diabetes. Based on a targeted review and a series of multidisciplinary workshops, an influence diagram was developed that captures newer concepts (e.g. continuous glucose monitoring metrics) that can be integrated into economic models and illustrates their association with more established concepts. How the additional continuous glucose monitoring-based indicators of glycaemic control may contribute to economic modelling beyond haemoglobin A1c, and more accurately reflect the economic value of novel type 1 diabetes treatments, is discussed.

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Acknowledgements

The authors thank Júlia Palotás, Research Associate at Evidera for her assistance with screening and extracting literature and editorial help. The authors also thank two anonymous reviewers who provided very helpful comments on an earlier version of the manuscript.

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Authors and Affiliations

  1. Evidera, Bocskai út 134-146. E/2, 1113, Budapest, Hungary

    Ágnes Benedict & Kinga Marczell

  2. Eli Lilly and Company, Indianapolis, IN, USA

    Emily R. Hankosky, Jieling Chen, Jay P. Bae & Brian D. Benneyworth

  3. Evidera, Waltham, MA, USA

    J. Jaime Caro

  4. PPD, Bethesda, MD, USA

    David J. Klein

Authors
  1. Ágnes Benedict
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  2. Emily R. Hankosky
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  3. Kinga Marczell
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  4. Jieling Chen
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  6. J. Jaime Caro
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Corresponding author

Correspondence to Ágnes Benedict.

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Funding

This study was funded by Eli Lilly and Company.

Conflicts of Interest/Competing Interests

ÁB, KM, JJC and DJK are employees of Evidera PPD, a consultancy that provides services to the pharmaceutical industry. Payments are made to Evidera PPD. ERH, JC, BDB and JPB are full-time employees of Eli Lilly and Company. ERH, JC, JPB and BDB hold stocks in Eli Lilly and Company.

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Availability of Data and Material

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.

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Author contributions

Á Benedict, ER Hankosky, K Marczell, J Chen made substantial contributions to concept, design of the review, analysis and interpretation as well as the drafting of the manuscript. D Klein, JJ Caro, JP Bae and BD Benneyworth contributed to the design, analysis and interpretation. The manuscript was drafted by Á Benedict, ER Hankosky, K Marczell, J Chen and JJ Caro. DJ Klein and JP Bae provided critical revision of the manuscript for important intellectual content. All authors participated sufficiently in the work to agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Jieling Chen was at Lilly at the time of the research and writing the manuscript.

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Benedict, Á., Hankosky, E.R., Marczell, K. et al. A Framework for Integrating Continuous Glucose Monitor-Derived Metrics into Economic Evaluations in Type 1 Diabetes. PharmacoEconomics 40, 743–750 (2022). https://doi.org/10.1007/s40273-022-01148-4

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