Cost-Effectiveness Analysis of a Hybrid Closed-Loop System Versus Multiple Daily Injections and Capillary Glucose Testing for Adults with Type 1 Diabetes
Abstract
Background: 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 glycemic 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 with 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 health care system. A lifetime 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 Australian dollars (AUD) 37,767 per quality-adjusted life year (QALY) gained. This is below the traditionally cited willingness to pay a threshold of $50,000 per QALY gained in the Australian setting. Sensitivity analyses that varied baseline glycemic control,…
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Multiple analyses have demonstrated the cost-effectiveness of AID, driven by significant reductions in diabetes-related complications.
“Multiple analyses have demonstrated the cost‐effectiveness of AID, driven by significant reductions in diabetes‐related complications.”
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“42,43 It is imperative that policymakers prioritize universal public funding for both insulin pumps and CGM to ensure equitable access to AID.”
- Authors
- Pease, A., Zomer, E., Liew, D., Earnest, A., Soldatos, G., Ademi, Z., & Zoungas, S.
- Affiliations
- Monash Health (AU)
- Monash University (AU)
- Alfred Health (AU)
- Corresponding author
- Zoungas, Sophia
- Venue
- Diabetes Technology & Therapeutics
- Publisher
- SAGE Publications
- Published
- 2020-11
- Volume
- 22
- Issue
- 11
- Pages
- 812-821
- ISSN
- 1520-9156 (ISSN-L)
- 1557-8593
- OpenAlex
- W3019470381
- Cited by
- 39
- References
- 13
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 5 · 2023: 2 · 2022: 11 · 2021: 10 · 2020: 1
- FWCI
- 4.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Technology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 1 diabetes, hybrid closed-loop system, insulin pump therapy, multiple daily insulin injections, cost-effectiveness, quality-adjusted life years, glycemic control, hypoglycemia, adults
- MeSH terms
- Adult, Australia, Blood Glucose, Cost-Benefit Analysis, Diabetes Mellitus, Type 1, Humans, Insulin, Insulin Infusion Systems, Quality-Adjusted Life Years
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