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

Diabetes care, 2022-09, Vol.45 (9), p.1971-1980 [Peer Reviewed Journal]

Copyright American Diabetes Association Sep 2022 ;ISSN: 0149-5992 ;EISSN: 1935-5548 ;DOI: 10.2337/dc21-2019

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  • Title:
    The Cost of Control: Cost-effectiveness Analysis of Hybrid Closed-Loop Therapy in Youth
  • Author: Pease, Anthony ; Callander, Emily ; Zomer, Ella ; Abraham, Mary B. ; Davis, Elizabeth A. ; Jones, Timothy W. ; Liew, Danny ; Zoungas, Sophia
  • Subjects: Closed loop systems ; Cost analysis ; Costs ; Decision analysis ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (insulin dependent) ; Economic analysis ; Effectiveness ; Glucose monitoring ; Health care ; Intravenous therapy ; Markov chains ; Pediatrics ; Research design ; Sensitivity analysis ; Teenagers ; Therapy ; Transition probabilities ; Young adults
  • Is Part Of: Diabetes care, 2022-09, Vol.45 (9), p.1971-1980
  • Description: 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.
  • Publisher: Alexandria: American Diabetes Association
  • Language: English
  • Identifier: ISSN: 0149-5992
    EISSN: 1935-5548
    DOI: 10.2337/dc21-2019
  • Source: GFMER Free Medical Journals
    Alma/SFX Local Collection
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