To Örebro University

Background and aims: Automated insulin delivery (AID) systems have revolutionized diabetes therapy: improving glucose levels while tremendously simplifying diabetes management for people living with diabetes. With AID uptake rapidly increasing, there is a need to assess the viability of widespread adoption for health care systems. This health economics study aims to provide a comprehensive analysis of the clinical and economic impact of AID across various patient groups in the Nordic region.

Materials and methods: We evaluated the cost-effectiveness of AID versus MDI+CGM over a 30 years’ time horizon. IQVIA Core Diabetes Model v.10 was used to simulate different patient cohorts based on published literature and country-specific cost data. The different patient groups analyzed were: children and youth with type 1 diabetes (T1D), adults with T1D, and adults with type 2 diabetes (T2D). Baseline HbA1c with MDI+CGM was: 7.9% for T1D children and youth, 9.0% for adults with T1D, and 9.1% for adults with T2D. Based on the selected studies, the following AID-attributable HbA1c reductions were applied: 0.7%, 1.4% and 1.3% respectively.

Results: Quality adjusted life years (QALY) gains were observed in all AID groups: 1.4 for children and youth with T1D, 1.5 for adults with T1D and 0.8 for adults with T2D. Reduced diabetes-related complications were observed in all groups; in T1D pediatrics 34% [SD: 1.9%], in T1D adults 48% [SD: 1.1%], in T2D adults 23% [SD:2.3%]. The incremental cost effectiveness ratio (ICER), which is used to assess cost-effectiveness, remained below all the country-specific willingness-to-pay (WTP) thresholds for all groups (Figure 1).

Conclusion: The use of AID systems leads to both short- and long-term clinical benefits alongside with reduced economic impact. In the Nordic region, AID has been shown to be a cost-effective therapy across all analyzed patient groups. These findings highlight the importance of appropriate budget allocation for diabetes technologies, which in turn contribute to reduced healthcare resources utilization. Expanding access to AID systems in the Nordics could provide significant benefits for patients, healthcare systems, and society as a whole.