To Örebro University

Background and aims: Automated insulin delivery (AID) systems help people living with diabetes (PwD) manage their glucose levels using automated insulin dose adjustment. Numerous studies provide evidence on AID systems effectiveness and the significant improvement of glycemic outcomes across diverse PwD populations. The aim of this study is to assess both the clinical and economic impact of AID compared to multiple daily insulin (MDI) or continuous subcutaneous insulin infusion (CSII) treatments in conjunction with continuous glucose monitoring (CGM) in Sweden.

Materials and methods: The IQVIA Core Diabetes Model v.10 was used to simulate 1000 individuals from different groups; pediatrics with type 1 diabetes (T1D), adults with uncontrolled T1D and adults with uncontrolled type 2 diabetes (T2D) on MDI across several time horizons (5, 15, 30 and 50 years). The corresponding mean baseline HbA1c levels in each group were 7.30%, 9.04% and 9.13%. After being randomized to an AID system all groups showed significant reductions of HbA1c levels: -0.40% vs. CSII+CGM, -1.42% vs. MDI+CGM and -1.30% vs. MDI + CGM respectively.

Results: The results suggest that across all time horizons AID therapy was associated with increased quality-adjusted life years (QALYs), risk reductions for long-term complications and direct cost savings. At 50 years, 22% [standard deviation (sd): 1.9%], 41% [sd: 1.9%] and 24% [sd: 2.4%] of events were averted in the pediatrics T1D, uncontrolled adults T1D and uncontrolled adults with T2D respectively. Direct costs were also reduced for all groups ranging from -8% to -22%. Incremental cost effectiveness ratio (ICER) for a 50 years’ time horizon was calculated based on QALY gains and total accumulated costs, resulting in -225,260 SEK/QALY [95% CI: -423,819 to -26,701] for the pediatric group, 154,684 SEK/QALY [95% CI: 139,594 to 169,774] for the uncontrolled T1D group and 562,065 SEK/QALY [95% CI: 507,326 to 616,803] for the uncontrolled T2D.

Conclusion: From a clinical perspective the analyzed groups would benefit from the use of AID systems, with risk reductions in diabetes-related complications both in the short- and in the long term. From an economic perspective, at a willingness-to-pay threshold of 500,000 SEK per QALY, AID systems are a cost-effective alternative to CSII and MDI in the pediatrics T1D, and uncontrolled adults T1D, and possibly cost-effective for uncontrolled T2D patient populations in Sweden. Therefore, AID systems are the therapeutic option that offer the maximum health gain while balancing health care costs for pediatrics and uncontrolled T1D and T2D on MDI.