Long-Term Cost-Effectiveness of an Advanced Hybrid Closed-Loop Automated Insulin Delivery System Versus Multiple Daily Insulin Injections Plus Continuous Glucose Monitoring in Adults with Type 1 Diabetes in Australia

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INTRODUCTION: The MiniMed™ 780G (MM780G) advanced hybrid closed-loop system has been shown to help improve glycemic control compared with continuous glucose monitoring plus multiple daily injections of insulin (MDI) in people with type 1 diabetes (T1D). The long-term health economic outcomes with MM780G versus MDI + CGM in people with T1D in Australia and HbA1c levels above target were investigated. METHODS: The analysis was performed using the IQVIA Core Diabetes Model. Clinical input data were sourced from a randomized controlled trial with HbA1c reductions of 1.54% for MM780G and 0.2% for MDI + CGM, from a baseline of 9.04%, were used in the analysis. The analysis was performed from a payer perspective over a time horizon of 50 years and an annual discount rate of 5% was applied to future costs and outcomes. RESULTS: In the base case, use of the MM780G was projected to lead to higher quality-adjusted life expectancy versus MDI + CGM (mean [SD] 13.32 [0.11] versus 11.81 [0.11] quality-adjusted life years [QALYs]; difference 1.51 QALYs). Mean [SD] total costs were also higher (AUD 367,341 [6700] versus AUD 317,819 [6943]), resulting in an incremental cost-effectiveness ratio (ICER) of AUD 32,840 per QALY gained. The results were most sensitive to changes in time horizon; over shorter time horizons (< 20 years) the ICER exceeded AUD 50,000 per QALY gained. Results were also sensitive to the inclusion of hypoglycemic event rates and the quality-of-life benefits associated with reduced fear of hypoglycemia. CONCLUSIONS: In Australia, in people with T1D and HbA1c above target, the use of the MM780G was projected to lead to improved long-term clinical outcomes versus MDI + CGM. Over a long-term time horizon, MM780G is likely to be cost-effective compared with MDI + CGM in this specific group of people.

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