Background Hybrid closed-loop systems may offer improved HbA1c levels, more time-in-range, and less hypoglycaemia than alternative treatment strategies. However, it is unclear if glycaemic improvements offset this technology’s higher acquisition costs. Among adults with type 1 diabetes in Australia, we sought to evaluate the cost-effectiveness of a hybrid closed-loop system in comparison to the current standard of care, comprising insulin injections and capillary glucose testing. Methods Cost-effectiveness analysis was performed using decision analysis in combination with a Markov model to simulate disease progression in a cohort of adults with type 1 diabetes and compare the downstream health and economic consequences of hybrid closed-loop therapy versus current standard of care. Transition probabilities and utilities were sourced from published studies. Costs were considered from the perspective of the Australian healthcare system. A lifetime time horizon was considered, with annual discount rates of 5% applied to future costs and outcomes. Uncertainty was assessed with probabilistic and deterministic sensitivity analyses. Results Use of a hybrid closed-loop system resulted in an incremental cost-effectiveness ratio of AUD $37,767 per quality adjusted life year (QALY) gained. This is below the traditionally cited willingness to pay threshold of $50,000 per QALY gained in the Australian setting. Sensitivity analyses that varied baseline glycaemic control, treatment effects, technology costs, age, discount rates, and time horizon indicated the results to be robust. Conclusions For adults with type 1 diabetes, hybrid closed-loop therapy is likely to be cost-effective compared to multiple daily injections and capillary glucose testing in Australia.
- Closed loop
- Type 1 diabetes
- Basal bolus insulin
Pease, A., Zomer, E., Liew, D., Earnest, A., Soldatos, G., Ademi, Z., & Zoungas, S. (Accepted/In press). Cost-effectiveness analysis of a hybrid closed-loop system versus multiple daily injections and capillary glucose testing for adults with type 1 diabetes. Diabetes Technology and Therapeutics. https://doi.org/10.1089/dia.2020.0064