Automated Insulin Delivery Versus Standard of Care in the Management of People Living with Type 1 Diabetes and HbA1c <8%: A Cost-Utility Analysis in The Netherlands.

Abstract

Introduction: Automated insulin delivery (AID) systems improve glycemic control in people living with type 1 diabetes (PwT1D). AID is cost-effective versus other management approaches in a range of country settings and populations. This cost-utility analysis adds an evaluation of the MiniMed^TM 780G system versus standard of care (SoC) in PwT1D and baseline glycated hemoglobin (HbA1c) level <8% not reaching glycemic targets, conducted from a societal perspective in The Netherlands. Methods: The analysis was run using the IQVIA CORE Diabetes Model, over 50 years. Costs were discounted at 3% per year, effects at 1.5% per year. Baseline cohort characteristics and treatment effects were sourced from the MiniMed 780G arm of a prospective multicenter study. Costs and utility estimates were taken from Dutch databases and published sources. Sensitivity analyses were conducted to address uncertainty. Results: AID improved life expectancy by 0.52 years and quality-adjusted life expectancy by 0.99 quality-adjusted life-years (QALYs) versus SoC. AID was associated with an incremental combined cost of EUR 28,635 due to higher acquisition costs, which were partially offset by reduced direct treatment costs for diabetes-related complications and reduced indirect costs due to less time off work. Based on combined costs, the MiniMed 780G system was associated with an incremental cost-utility ratio of EUR 29,836 per QALY gained. Conclusions: For PwT1D in The Netherlands, who had a baseline HbA1c <8% and do not reach glycemic targets, AID system initiation was projected to improve long-term clinical outcomes and reduce both direct costs for the treatment of diabetes-related complications and productivity losses. From a societal perspective, the MiniMed 780G likely represents good value for money in The Netherlands.