The Cost-effectiveness of a Continuous Glucose Monitoring Device for Adult Diabetes Patients in Ethiopia: A Semi-Markov Modelling Study
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Background
Diabetes Mellitus is a chronic condition requiring regular blood glucose monitoring to prevent acute complications and long-term vascular damage. While standard glucometers are commonly used, continuous glucose monitoring (CGM) devices offer real-time insights into glucose fluctuations, improving glycemic control. However, cost-effectiveness data on CGM use in low-resource settings like Ethiopia remains limited.
Methods
A semi-Markov model was developed to evaluate the cost-effectiveness of CGM compared to standard self-monitoring of blood glucose in adult diabetes patients in Ethiopia. The analysis incorporated costs from a societal perspective and lifetime horizon, health utilities, and transition probabilities from local and global sources. Primary outcomes included incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB) at a willingness-to-pay threshold of one times Ethiopia’s GDP per capita (ETB 165,000).
Results
CGM was associated with ICERs of ETB 155,625, ETB 135,353, and ETB 59,718 per QALY gained for males aged 20, 40, and 60 years, respectively. For females, the ICERs were higher at ETB 156,881, ETB 140,290, and ETB 69,791 per QALY for the same age groups, with cost-effectiveness improving with age. Net monetary benefit (NMB) results were positive for the average cohort starting age of 20, 40 and 60 in both male and female categories. One-way and probabilistic sensitivity analyses confirmed the robustness of these findings, with cost and health outcome discount rates identified as key drivers of parameter uncertainty.
Conclusion
CGM is a cost-effective intervention for diabetes management in Ethiopia, particularly in older adults. Its adoption could reduce complications and improve health outcomes, but affordability barriers for younger populations warrant further policy considerations.
