Closed-Loop Insulin System Is Cost-effective in Type 1 Diabetes, Analysis Says

Lower indirect costs and a lower incidence of serious complications offset the higher cost of the advanced hybrid closed-loop insulin system.

Advanced hybrid closed-loop insulin monitoring and delivery systems are cost-effective for patients with type 1 diabetes compared with intermittent glucose scanning plus self-injection or continuous subcutaneous insulin infusion, according to a new economic analysis in Sweden.

The study, published in Diabetes Therapy, used a cost-effectiveness threshold of 500,000 Swedish krona (SEK) per quality-adjusted life year (about $57,000 US dollars). It focused on the MiniMed 780G system, which is manufactured by Medtronic, and which automatically administers insulin in response to fluctuations in blood glucose.

The study’s corresponding author, Johan Jendle, MD, PhD, Örebro University, in Sweden, explained that new technologies have substantially improved glycemic control in patients with type 1 diabetes, but they also bring significant increases in the cost of care. As such, the investigators said, new devices warrant economic scrutiny to see whether they bring improvements in care sufficient to justify the cost.

In the case of MiniMed 780G, Jendle and colleagues calculated that the extra direct cost of using that device rather than intermittently scanned continuous glucose monitoring (isCGM) and self-injection or continuous infusion would be about US $83,000 over the life of the patient.

To find out whether those excess costs could be justified, the investigators used a mix of data and modeling. The model incorporated glycated hemoglobin (HbA1c) and hypoglycemia rates from observational studies and a randomized crossover trial. In addition, data such as missed days of work were estimated based on existing published sources. The model was based on the premise that the patients received the interventions for their lifetimes.

The authors found that using the MiniMed device would lead to a small improvement in life expectancy (0.16 years), and a larger improvement in quality-adjusted life expectancy (1.95 quality-adjusted life years).

“Greater reductions in HbA1c and severe hypoglycemic events yielded improved life expectancy and quality-adjusted life expectancy over the long term, a result of the reduced incidence and increased time to onset of diabetes-related complications with the MiniMed 780G system,” Jendle and colleagues wrote.

The investigators calculated that rates of complications such as amputations, end-stage renal disease, diabetic retinopathy, and myocardial infarction would be lower if patients used the MiniMed system, instead of the isCGM system. They also found indirect costs, such as lost work time, would be lower for those using the advanced hybrid closed-loop system. In fact, though direct costs were much higher for the MiniMed 780G, indirect costs were calculated to be about $12,600 US dollars lower for MiniMed 780G users..

In the Swedish context, the authors said the MiniMed device could help solve high rates of HbA1c.

“Prescribing such a device could therefore help to further improve diabetes care, considering the high mean levels of HbA1c and low insulin pump uptake still observed in people with type 1 diabetes in Sweden,” the authors wrote.

Jendle and colleagues said their study was limited by the nature of using short-term data to make long-term projections. They also noted that it was based on a particular country’s context.

Still, they said these data help to show the benefits that can accrue when patients spend more time in their target blood glucose ranges.

Reference

Jendle J, Buompensiere MI, Holm AL, de Portu S, Malkin SJP, Cohen O. The cost-effectiveness of an advanced hybrid closed-loop system in people with type 1 diabetes: A health economic analysis in Sweden. Diabetes Ther. 2021;12(11):2977-2991. doi:10.1007/s13300-021-01157-0