Intermittently Scanned Continuous Glucose Monitoring with Multiple Daily Insulin Injections in People Living with Type 1 Diabetes

2023 Oct 6.

doi: 10.1089/dia.2023.0297. 

Johan Jendle  ¹ , Maria Ida Buompensiere  ² , Asli Zeynep Ozdemir Saltik  ³ , Simona de Portu  ⁴ , Jayne Smith-Palmer  ⁵ , Richard Pollock  ⁶ , Ohad Cohen  ⁷

Background

Advanced hybrid closed-loop (AHCL) automated insulin delivery systems are the most effective therapy in terms of assisting people with type 1 diabetes (T1D) to achieve glycemic targets; however, the cost can represent a barrier to uptake.

Here, a cost-utility analysis of the MiniMedTM 780G AHCL system (MM780G) versus intermittently-scanned continuous glucose monitoring (is-CGM) plus multiple daily insulin injections (MDI) in people with T1D not achieving glycemic goals was performed across six European countries.

Methods

Clinical input data were sourced from the ADAPT trial. Assuming a baseline HbA1c of 9.04%, HbA1c reductions of 1.54% for AHCL and 0.2% for is-CGM+MDI were assumed. The analyses were performed from a payer perspective over a time horizon of 40 years and an annual discount rate of 3% was applied.

Results

Across all countries, the use of AHCL was projected to result in an incremental gain in quality-adjusted life expectancy of >2 quality-adjusted life years (QALYs) versus is-CGM+MDI. Lifetime direct costs were higher with AHCL resulting in incremental cost-utility ratios for AHCL versus is-CGM+MDI ranging from EUR 11,765 per QALY gained in Austria to EUR 43,963 per QALY gained in Italy.

Conclusions

For people with T1D managed with is-CGM+MDI not achieving glycemic targets, initiation of the MM780G system was projected to improve long-term clinical outcomes; however, due to differences in healthcare costs between countries, the health economic outcomes differ.

In the countries included here, AHCL is likely to be cost-effective relative to is-CGM+MDI for people not achieving glycemic goals with is-CGM+MDI.

Läs abstract 

https://www.liebertpub.com/doi/10.1089/dia.2023.0297

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