Hybrid closed-loop systems cost-effective option for blood sugar control in T1D

Hybrid closed-loop therapy is likely to be cost-effective compared with multiple daily injections and capillary glucose for Type 1 diabetes patients according to a study published in Diabetes Technology & Therapeuticson November 9, 2020.

Technologies have been implemented as early as the 1970s in an effort to control blood sugar levels. Since then, there has been rapid development and production of devices and applications to facilitate more accurate insulin delivery and improve the precision and ease of measuring blood sugar levels. However, new technologies can be expensive and often need to be privately funded. Hybrid closed-loop systems may offer improved HbA1c levels, more time-in-range, and less hypoglycemia than alternative treatment strategies. However, it is unclear if blood sugar improvements offset this technology's higher acquisition costs. For this purpose researchers evaluate the cost-effectiveness of a hybrid closed-loop system in comparison with the current standard of care, comprising insulin injections and capillary glucose testing among adults with type 1 diabetes.

Researchers performed cost-effectiveness analysis using decision analysis in combination with a Markov model to simulate disease progression in a cohort of adults with type 1 diabetes. They compared the downstream health and economic consequences of hybrid closed-loop therapy with the current standard of care. They analysed the published studies to determine transition probabilities and utilities. A lifetime horizon was considered, with annual discount rates of 5% applied to future costs and outcomes. The major outcome assessed was costs and cost-effectiveness

After the analysis, researchers found the use of a hybrid closed-loop system resulted in an incremental cost-effectiveness ratio of Australian dollars (AUD) 37,767 per quality-adjusted life year (QALY) gained which is below the traditionally cited willingness to pay a threshold of $50,000 per QALY gained in the Australian setting. Upon sensitivity analyses that varied baseline glycemic control, treatment effects, technology costs, age, discount rates, and time horizon they found the results to be robust.

By considering from the perspective of the Australian health care system this study suggests hybrid closed-loop therapy is cost-effective when compared with multiple daily injections and capillary glucose testing in patients with type 1 diabetes.