ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Diabetes Care. 2018;41:1227-1234

Health care is being delivered by organizations that can be regarded as representing ´health industries´. Health care providers work within complex financial constraints and frequently within for profit settings and tight financial frameworks. Hence, health provision is more and more driven by cost-effectiveness and the willingness of either patients or health insurances or societies to pay costs of a given service. Mortality and morbidity as well as social participation and quality of life as assessed as measuring QALYs (quality-adjusted life years) are considered endpoints for both the efficacy and effectiveness within clinical studies as well as for the financial adequacy and cost-effectiveness. As there are many patients with diabetes cost-effectiveness of diabetes care is considered an important financial issue in a society.

Re-imbursement of continuous glucose monitoring devices as well as of insulin pumps for the treatment of T1DM by insurance companies and public health agencies largely depends upon its cost-effectiveness and efficacy.

The DIAMOND clinical trial evaluated the societal cost-effectiveness of continuous glucose monitoring (CGM) in adult patients with T1DM (T1D) using multiple insulin injections and showed an overall cost-effectiveness. The authors concluded that CGM is worthwhile when used in adults. It is important to note that costs of CGM has to be weighed against the costs of test strip use, morbidity, mortality and quality of life as well as participation in the work force. All of these aspects will be even more pronounced when analyzed in the pediatric population since the factor of time and longitudinal calculations will extend the findings in adults and might actually show that the calculations done for the adult population will be exceeded and advantages of CGM over conventional treatments will even be more pronounce at a young age.