The Cost of Control: Cost-effectiveness Analysis of Hybrid Closed-Loop Therapy in Youth

Abstract

OBJECTIVE Hybrid closed-loop (HCL) therapy is an efficacious management strategy for young people with type 1 diabetes. However, high costs prevent equitable access. We thus sought to evaluate the cost-effectiveness of HCL therapy compared with current care among young people with type 1 diabetes in Australia. RESEARCH DESIGN AND METHODS A patient-level Markov model was constructed to simulate disease progression for young people with type 1 diabetes using HCL therapy versus current care, with follow-up from 12 until 25 years of age. Downstream health and economic consequences were compared via decision analysis. Treatment effects and proportions using different technologies to define “current care” were based primarily on data from an Australian pediatric randomized controlled trial. Transition probabilities and utilities for health states were sourced from published studies. Costs were considered from the Australian health care system’s perspective. An annual discount rate of 5% was applied to future costs and outcomes. Uncertainty was evaluated with probabilistic and deterministic sensitivity analyses. RESULTS Use of HCL therapy resulted in an incremental cost-effectiveness ratio of Australian dollars (AUD) $32,789 per quality-adjusted life year (QALY) gained. The majority of simulations (93.3%) were below the commonly accepted willingness-to-pay threshold of AUD $50,000 per QALY gained in Australia. Sensitivity analyses indicated that the base-case results were robust. CONCLUSIONS In this first cost-effectiveness analysis of HCL technologies for the management of young people with type 1 diabetes, HCL therapy was found to be cost-effective compared with current care in Australia.

Nationally Subsidized Continuous Glucose Monitoring: A Cost-effectiveness Analysis

“…The current Markov model represents an updated version of our recently reported authorcreated model. The comparison of modelled outcomes with the published literature therefore closely mirrors our prior manuscript (50). …”

“…The comparison of modelled outcomes with the published literature therefore closely mirrors our prior manuscript. (50) The absolute normalized differences between modelled and observed results were often less than 5% and most were less than 15%. End stage renal disease had a larger absolute normalized difference of 50% due to low event rates with an observed and modelled incidence of 0.8% versus 1.2%, respectively.…”

“…• Different approach to modelling the intervention. Rather than assuming 100% of the intervention arm used a particular diabetes management technology, (50) the current version of the model considered proportions of people using CGM, capillary glucose testing, multiple daily injections of insulin or insulin pump therapy among those with versus without subsidized access to CGM. This was facilitated by the real-world datasource informing our analysis.…”

“…The comparison of modelled outcomes with the published literature therefore closely mirrors our prior manuscript with updates for modelled outcomes over a shorter time horizon. (50) Australian national data reported that the annual mortality rate for people living with type 1 diabetes under 45 years of age is 251 per 100,000 persons. (51) This equates to 2.51 deaths per 100 persons (i.e.…”

Real world use of hybrid‐closed loop in children and young people with type 1 diabetes mellitus—a National Health Service pilot initiative in England

“…Such considerations need to be added into any overall assessment of cost effectiveness along with an estimate of the value of reduced diabetes burden. 24 There were no differences in any of the outcome measures between the different HCL systems used. It should be stressed however, that the study was not designed as a superiority or non-inferiority study but in terms of the real world choice of HCL system does not seem to impact on outcome.…”