Cost-Effectiveness of Age-Specific Remote Education to Initiate and Sustain Use of CGM in Older Adults with Diabetes on Insulin

Introduction and Objective: Older adults on insulin have high risk of diabetes and cardiovascular (CVD) complications, yet the health economic value of geriatric-tailored continuous glucose monitoring (CGM) education is poorly characterized. We projected 10-year clinical outcomes, costs, and quality-adjusted life years (QALY) associated with REST study-informed A1c improvement. Methods: The REST study enrolled adults ≥65 years on insulin (type 1 (T1D) or type 2 diabetes (T2D)) and either CGM naive or CGM users not meeting glycemic targets (TIR <40% and/or hypoglycemia >4%). The intervention combined remote CGM education with geriatric principles, including individualized glycemic goals and insulin regimen simplification based on CGM patterns. We used the CDC/RTI discrete-time diabetes microsimulation model (risk-equation-based projections of complications, costs, and QALYs), using the data from REST, and compared a REST-informed scenario vs usual care by applying an adjusted mean A1c reduction of 0.49% over 6 months. Simulations were run separately for T1D and T2D. Ten-year outcomes included total medical costs, QALYs, mortality, and diabetes/CVD complications. Results: Over 10 years (mean modeled follow-up 7.5 years), the model projected lower complication risk and mortality in REST vs. usual care. For T1D, projected reductions included MACE −2.54%, ESRD −6.53%, proliferative diabetic retinopathy −17.4%, amputation −12.8%, and mortality −2.85%. For T2D, projected reductions included stroke −2.52%, MI −2.76%, revascularization −2.83%, dialysis −5.01%, and mortality −2.17%. QALYs increased by +0.075 in T1D and +0.040 in T2D, with small increases in modeled medical costs (+$87 and +$71). With a $1,000 program cost assumption, implied cost per QALY was $14,493 for T1D and $26,775 for T2D. Conclusion: REST-informed projections indicate lower diabetes/CVD complications and better quality-adjusted survival over 10 years, with minimal added cost, supporting this scalable remote education for older adults on insulin. Disclosure: A. Adam: None. S. Neuwahl: Other - Working on a project for this client as part of my normal duties as a health economist at my employer (RTI international).; Current; Eli Lilly and Company, Sanofi. C. Slyne: None. M. Savory: None. N. Krakoff: None. J. Bulger: None. H. Brabant: None. Z. Tayebali: None. R. Weinstock: Research Support; Current; Amgen Inc., Eli Lilly and Company, JDRF, Diasome, DEKA Research and Development, Tandem Diabetes Care, Inc. Research Support; Ended; Kowa Research Institute, Inc. Research Support; Current; National Institutes of Health. Research Support; Ended; Insulet Corporation. Research Support; Current; T1D Exchange. M. Munshi: Advisory Panel; Current; Abbott Diabetes. Research Support; Ended; Dexcom, Inc. E. Toschi: Consultant; Current; Vertex Pharmaceuticals Incorporated. Advisory Panel; Current; Vertex Pharmaceuticals Incorporated. Funding: Funded provided by The Leona M. and Harry B. Helmsley Charitable Trust