Clinical and economic benefits of integrated pump/CGM technology therapy in patients with type 1 diabetes in Colombia

Gómez, Ana María; Alfonso-Cristancho, Rafael; Orozco, John Jairo; Lynch, Peter; Prieto, Diana; Saunders, Rhodri; Roze, S; Valencia, J.

doi:10.1016/j.endoen.2016.10.009

Cited by 10 publications

(10 citation statements)

References 29 publications

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“…11 The integrated CSII/CGM therapy (i.e., CGM+CSII) likely represents a cost-effective treatment option relative to CSII alone, 54 as well as a cost-effective alternative to MDI without CGM. 55…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of Initiating an Insulin Pump in T1D Adults Using Continuous Glucose Monitoring Compared with Multiple Daily Insulin Injections: The DIAMOND Randomized Trial

et al. 2018

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Background: The economic impact of both continuous glucose monitoring (CGM) and insulin pumps (continuous subcutaneous insulin infusion (CSII)) in Type 1 diabetes (T1D) have been evaluated separately. However, the cost-effectiveness of adding CSII to existing CGM users has not yet been assessed. Objective: To evaluate the societal cost-effectiveness of CSII versus continuing multiple daily injections (MDI) in adults with T1D already using CGM. Methods: In the second phase of the DIAMOND trial, 75 adults using CGM were randomized to either CGM+CSII or CGM+MDI (control) and surveyed at baseline and 28 weeks. We performed within-trial and lifetime cost-effectiveness analyses (CEAs) and estimated lifetime costs and quality-adjusted life years (QALYs) via a modified Sheffield T1D model. Results: Within the trial, the CGM+CSII group had a significant reduction in quality of life from baseline (−0.02 ± 0.05 difference in difference (DiD)), compared to controls. Total per-person 28-week costs were $8,272 (CGM+CSII) vs $5,623 (CGM+MDI); the difference in costs was primarily attributable to pump use ($2,644). Pump users reduced insulin intake (−12.8 units DiD), but increased use of daily number of test strips (+1.2 DiD). Pump users also increased time with glucose in range 70–180 mg/dL, but had higher HbA1c (+0.13 DiD) and more non-severe hypoglycemic events. In the lifetime CEA, CGM+CSII would increase total costs by $112,045 DiD, decrease QALYs by 0.71, and life expectancy by 0.48 years. Conclusions: Based on this single trial, initiating an insulin pump in adults with T1D already using CGM was associated with higher costs and reduced quality of life. Additional evidence regarding the clinical effects of adopting combinations of new technologies from trials and real-world populations are needed to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of Initiating an Insulin Pump in T1D Adults Using Continuous Glucose Monitoring Compared with Multiple Daily Insulin Injections: The DIAMOND Randomized Trial

et al. 2018

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“…Integrated systems with low glucose suspend had QALYs 0.04-2.99 higher than CSII with SMBG [51,56]. The largest difference in QALYs was reported by Gomez et al, with integrated systems involving CGM alarms being 3.81 higher than MDI with SMBG [43]. Sensitivity analyses by Ly et al reported ICERs of $40,803 (AUD 2013) per QALY which increased to $382,954 (AUD 2013) per QALY for a utility value of 0.0075, and decreased to $21,565 (AUD 2013) per QALY with a utility value of 0.1390 [51].…”

Section: Determinants Of Cost-effectivenessmentioning

confidence: 90%

“…The only economic evaluation that considered integrated systems with CGM alarms compared to MDI with SMBG utilised their own review article (in Spanish) as the source for their clinical assumptions [43]. Authors reported the largest treatment effect of interventions from any study, citing HbA1c reductions of 1.5% (16.4 mmol/mol) and severe hypoglycaemia rates reducing from 5.22 to 0.37 events per patient/year [43].…”

Section: Modelled Treatment Effects Of Diabetes Management Technologymentioning

confidence: 99%

Cost-effectiveness of health technologies in adults with type 1 diabetes: a systematic review and narrative synthesis

et al. 2020

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Background: With the rapid development of technologies for type 1 diabetes, economic evaluations are integral in guiding cost-effective clinical and policy decisions. We therefore aimed to review and synthesise the current economic literature for available diabetes management technologies and outline key determinants of costeffectiveness. Methods: A systematic search was conducted in April 2019 that focused on modelling or trial based economic evaluations. Searched databases included Medline, Medline in-process and other non-indexed citations, EMBASE, PubMed, All Evidenced Based Medicine Reviews, EconLit, Cost-effectiveness analysis Registry, Research Papers in Economics, Web of Science, PsycInfo, CINAHL, and PROSPERO from inception. We assessed quality of included studies with the Questionnaire to Assess Relevance and Credibility of Modeling Studies for Informing Health Care Decision Making an ISPOR-AMCP-NPC good practice task force report. Screening of abstracts and full-texts, appraisal, and extraction were performed by two independent researches. Results: We identified 16,772 publications, of which 35 were analysed and included 11 health technologies. Despite a lack of consensus, most studies reported that insulin pumps (56%) or interstitial glucose sensors (62%) were costeffective, although incremental cost-effectiveness ratios ranged widely ($14,266-$2,997,832 USD). Cost-effectiveness for combined insulin pumps and glucose sensors was less clear. Determinants of cost-effectiveness included treatment effects on glycosylated haemoglobin and hypoglycaemia, costing of technologies and complications, and measures of utility. Conclusions: Insulin pumps or glucose sensors appeared cost-effective, particularly in populations with higher HbA1c levels and rates of hypoglycaemia. However, cost-effectiveness for combined insulin pumps and glucose sensors was less clear. Registration: The study was registered with PROSPERO, number CRD42017077221.

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“…Although the early versions of SAPs have shown little or no benefit over MDI supported by CGM, 93 an economic simulation that considered SAP systems with alarms compared with MDI showed that SAP improved mean life expectancy by an additional 3.51 years compared with MDI, with a delayed onset of diabetes-related complications and an increase in survival time free of complications. 94 The estimated ICER for integrated pump/CGM was approximately $23 200 per QALY gained. 94 A 2017 economic modeling analysis concluded that SAP with automated insulin suspension was a cost-effective option and associated with better life expectancy and quality-adjusted life expectancy than CSII for the management of persons with T1D and a history of severe hypoglycemic events or poor glycemic control despite the use of CSII in Sweden.…”

Section: Continuous Glucose Monitoring Technologiesmentioning

confidence: 99%

American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus

et al. 2021

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automated insulin dosing continuous glucose monitoring continuous subcutaneous insulin infusion diabetes diabetes technology glucose sensors hybrid closed loop insulin pumps sensor-augmented pump low-glucose suspend predictive low-glucose suspend a b s t r a c t Objective: To provide evidence-based recommendations regarding the use of advanced technology in the management of persons with diabetes mellitus to clinicians, diabetes-care teams, health care professionals, and other stakeholders. Methods: The American Association of Clinical Endocrinology (AACE) conducted literature searches for relevant articles published from 2012 to 2021. A task force of medical experts developed evidence-based guideline recommendations based on a review of clinical evidence, expertise, and informal consensus, according to established AACE protocol for guideline development. Main Outcome Measures: Primary outcomes of interest included hemoglobin A1C, rates and severity of hypoglycemia, time in range, time above range, and time below range. Results: This guideline includes 37 evidence-based clinical practice recommendations for advanced diabetes technology and contains 357 citations that inform the evidence base.Recommendations: Evidence-based recommendations were developed regarding the efficacy and safety of devices for the management of persons with diabetes mellitus, metrics used to aide with the assessment of advanced diabetes technology, and standards for the implementation of this technology. Conclusions: Advanced diabetes technology can assist persons with diabetes to safely and effectively achieve glycemic targets, improve quality of life, add greater convenience, potentially reduce burden of Disclaimer: The American Association of Clinical Endocrinology medical guidelines for clinical practice are systematically developed statements to assist health care professionals in medical decision-making for specific clinical conditions. Most of the content herein is based on clinical evidence. In areas of uncertainty, or when clarification is required, expert opinion and professional judgment were applied.This guideline is a working document that reflects the state of the field at the time of publication. Because rapid changes are expected in this area, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made considering local resources and individual patient circumstances.

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Clinical and economic benefits of integrated pump/CGM technology therapy in patients with type 1 diabetes in Colombia

Cited by 10 publications

References 29 publications

Cost-effectiveness of Initiating an Insulin Pump in T1D Adults Using Continuous Glucose Monitoring Compared with Multiple Daily Insulin Injections: The DIAMOND Randomized Trial

Cost-effectiveness of Initiating an Insulin Pump in T1D Adults Using Continuous Glucose Monitoring Compared with Multiple Daily Insulin Injections: The DIAMOND Randomized Trial

Cost-effectiveness of health technologies in adults with type 1 diabetes: a systematic review and narrative synthesis

American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus

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