Cost analysis of the flash monitoring system (FreeStyle Libre 2) in adults with type 1 diabetes mellitus
Open accessAbstract
INTRODUCTION: Compare cost of the interstitial liquid glucose flash monitoring (FM) system (FreeStyle Libre 2) versus self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes mellitus (T1DM) in Spain. RESEARCH DESIGN AND METHODS: A model was developed to estimate, with the perspective of the Spanish health system, the annual costs associated with glucose monitoring and hypoglycemic events management in T1DM population, with multiple insulin daily doses (MDI). According to published evidence, rate of severe hypoglycemia (SHE) of 4.90 episodes per patient-year was applied. Reduction of SHE (58.6%) was modeled associated with FM use. Published rates of hospital care (20.2%) and subsequent admission (16%) were assumed for SHE. The daily consumption of strips and lancets was 9 in patients with SMBG (before and after 4 daily intakes and at bedtime) and 0.5 for FM users (according to IMPACT trial findings). Annual consumption of 26 FM sensors was considered (1 every 14 days). Unit costs (in € of 2019, excluding VAT) were obtained from literature and national databases. Sensitivity analyses (SA) were carried out to evaluate the model robustness. RESULTS: The total annual cost/patient was €4437 for SMBG and €2526 for FM. The use of FM would be associated with an annual savings in the costs of monitoring and managing hypoglycemic events of €1911 per patient-year. In a hypothetical cohort of 1000 patients with T1DM MDI, FM could avoid in 1 year 4900 SHE, 93 hospitalizations for SHE. In addition, the use of FM would generate total savings of up to €1 910 000 per year. In the SA with alternative hypoglycemia events rates and use of strips and lancets, and including non-SHE episodes, savings from €370 000 to €1 760 000 were observed with FM. CONCLUSIONS: The use of the FM system to monitor glucose in adults with T1DM treated with MDI, would reduce hypoglycemic events and would result in cost savings for the health system.
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Insulin pump therapy and CGM reduce HbA1c, hypoglycaemia, diabetes burden and distress, and are associated with higher quality of life compared to usual care.
“Insulin pump therapy and continuous glucose monitor (CGM) reduce Haemoglobin A1c (HbA1c), hypoglycaemia, diabetes burden and distress, and are associated with higher quality of life (QOL) compared to usual care.”
From Social disadvantage and technology use among adults with type 1 diabetes in Quebec: A cross‐sectional study using data from the Canadian <scp>T1D</scp> ( <scp>BETTER</scp> ) Registry (2025) · cites this paper as [3]
The Introduction and Research design and methods (pages unavailable) report fewer hypoglycaemic episodes with flash monitoring than with finger-prick self-monitoring in adults with type 1 diabetes. The paper analyses people receiving multiple daily insulin doses, not insulin pump therapy, and does not establish reductions in HbA1c, diabetes burden or distress, or improved quality of life for the therapies named in the claim. (LLM, conf=0.88)
Experimental — accuracy not yet measuredEconomic analyses generally support the cost-effectiveness of diabetes technologies owing to a reduction in hypoglycaemia and acute and chronic diabetes complications.
“While these technologies are expensive, economic analyses generally support their cost‐effectiveness owing to a reduction in hypoglycaemia and acute and chronic diabetes complications.”
From Social disadvantage and technology use among adults with type 1 diabetes in Quebec: A cross‐sectional study using data from the Canadian <scp>T1D</scp> ( <scp>BETTER</scp> ) Registry (2025) · cites this paper as [3]
The Conclusions (page unavailable) report that flash monitoring was associated with lower modeled costs for adults with type 1 diabetes, chiefly through fewer hypoglycemic episodes; they also note cost savings reported in other settings. The paper does not establish that diabetes technologies generally are cost-effective or that reductions in acute and chronic complications drive those savings. (LLM, conf=0.87)
Experimental — accuracy not yet measuredPrevious studies demonstrate glycaemic benefits for CGM and insulin pump.
“HbA1c was lower among CGM and insulin pump users in the BETTER Registry, which is consistent with previous studies demonstrating glycaemic benefits for these technologies.”
From Social disadvantage and technology use among adults with type 1 diabetes in Quebec: A cross‐sectional study using data from the Canadian <scp>T1D</scp> ( <scp>BETTER</scp> ) Registry (2025) · cites this paper as [3]
The Introduction reports that a trial found fewer hypoglycaemic episodes with flash glucose monitoring, supporting a glycaemic benefit for that technology. The paper does not report a glycaemic benefit for insulin pumps, and the Research design and methods table gives baseline HbA1c rather than an HbA1c reduction. Neither passage has a page number in our copy. (LLM, conf=0.87)
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Severe hypoglycemia and risks of vascular events and death
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“1,3,5 After CGM use increased in Australia following the introduction of public funding, HbA1c and rates of DKA were reduced.”
- Authors
- Oyagüez, I., Merino-Torres, J. F., Brito, M., Bellido, V., Cardona-Hernandez, R., Gomez-Peralta, F., & Morales-Perez, F.
- Affiliations
- Iberia (Spain) (ES)
- Universitat de València (ES)
- Hospital Universitario Puerta de Hierro Majadahonda (ES)
- Hospital de Cruces (ES)
- Division of Pediatric Endocrinology, Hospital Sant Joan de Deu, Barcelona, Catalunya, Spain
- Endocrinology and Nutrition Unit, Segovia General Hospital, Segovia, Spain
- Department of Endocrinology and Nutrition, University Hospital Complex Badajoz, Badajoz, Extremadura, Spain
- Corresponding author
- Oyagüez, Itziar
- Venue
- BMJ Open Diabetes Research & Care
- Publisher
- BMJ
- Published
- 2020-07
- Volume
- 8
- Issue
- 1
- Pages
- e001330
- ISSN
- 2052-4897 (ISSN-L)
- PMC
- PMC7375427
- OpenAlex
- W3045463944
- Cited by
- 33
- References
- 7
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 7 · 2023: 6 · 2022: 7 · 2021: 6 · 2020: 1
- FWCI
- 3.77
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMJ Open Diabetes Research & Care (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Abbott Diabetes Care (Abbott-Dc-2019-03)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- flash glucose monitoring, FreeStyle Libre 2, type 1 diabetes, cost analysis, self-monitoring of blood glucose, severe hypoglycemia, hypoglycemia management, hospital costs, cost reduction, health system costs, adults
- MeSH terms
- Adult, Blood Glucose, Diabetes Mellitus, Type 1, Humans, Hypoglycemic Agents, Spain, Blood Glucose Self-Monitoring
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