Cost-Effectiveness of Closed-Loop Automated Insulin Delivery Using the Cambridge Hybrid Algorithm in Children and Adolescents with Type 1 Diabetes: Results from a Multicenter 6-Month Randomized Trial-Reference-Cited by-同舟云学术

Cost-Effectiveness of Closed-Loop Automated Insulin Delivery Using the Cambridge Hybrid Algorithm in Children and Adolescents with Type 1 Diabetes: Results from a Multicenter 6-Month Randomized Trial

Published:2024-03-17 Issue: Volume: Page:
ISSN:1932-2968
Container-title:Journal of Diabetes Science and Technology
language:en
Short-container-title:J Diabetes Sci Technol

Author:

Fox D. Steven¹^ORCID,Ware Julia²³^ORCID,Boughton Charlotte K²⁴^ORCID,Allen Janet M.²,Wilinska Malgorzata E²³,Tauschmann Martin²³,Denvir Louise⁵,Thankamony Ajay³,Campbell Fiona⁶,Wadwa R. Paul⁷^ORCID,Buckingham Bruce A.⁸^ORCID,Davis Nikki⁹,DiMeglio Linda A.¹⁰,Mauras Nelly¹¹,Besser Rachel E. J.¹²¹³^ORCID,Ghatak Atrayee¹⁴,Weinzimer Stuart A.¹⁵,Kanapka Lauren¹⁶^ORCID,Kollman Craig¹⁶,Sibayan Judy¹⁶,Beck Roy W.¹⁶,Hood Korey K.⁸^ORCID,Hovorka Roman¹²^ORCID

Affiliation:

1. Department of Pharmaceutical and Health Economics, Mann School of Pharmacy, University of Southern California, Los Angeles, CA, USA

2. Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK

3. Department of Paediatrics, University of Cambridge, Cambridge, UK

4. Department of Diabetes & Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

5. Department of Paediatric Diabetes and Endocrinology, Nottingham University Hospitals NHS Trust, Nottingham, UK

6. Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds, UK

7. Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

8. Stanford University School of Medicine, Stanford Diabetes Research Center, Stanford, CA, USA

9. Department of Paediatric Endocrinology and Diabetes, Southampton Children's Hospital, Southampton General Hospital, Southampton, UK

10. Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA

11. Nemours Children's Health, Jacksonville, FL, USA

12. Oxford University Hospitals NHS Foundation Trust, NIHR Oxford Biomedical Research Centre, Oxford, UK

13. Department of Paediatrics, University of Oxford, Oxford, UK

14. Alder Hey Children’s Hospital, Liverpool, UK

15. Department of Pediatrics, Yale University, New Haven, CT, USA

16. The Jaeb Center for Health Research, Tampa, FL, USA

Abstract

Background/Objective: The main objective of this study is to evaluate the incremental cost-effectiveness (ICER) of the Cambridge hybrid closed-loop automated insulin delivery (AID) algorithm versus usual care for children and adolescents with type 1 diabetes (T1D). Methods: This multicenter, binational, parallel-controlled trial randomized 133 insulin pump using participants aged 6 to 18 years to either AID (n = 65) or usual care (n = 68) for 6 months. Both within-trial and lifetime cost-effectiveness were analyzed. Analysis focused on the treatment subgroup (n = 21) who received the much more reliable CamAPS FX hardware iteration and their contemporaneous control group (n = 24). Lifetime complications and costs were simulated via an updated Sheffield T1D policy model. Results: Within-trial, both groups had indistinguishable and statistically unchanged health-related quality of life, and statistically similar hypoglycemia, severe hypoglycemia, and diabetic ketoacidosis (DKA) event rates. Total health care utilization was higher in the treatment group. Both the overall treatment group and CamAPS FX subgroup exhibited improved HbA1C (−0.32%, 95% CI: −0.59 to −0.04; P = .02, and −1.05%, 95% CI: −1.43 to −0.67; P < .001, respectively). Modeling projected increased expected lifespan of 5.36 years and discounted quality-adjusted life years (QALYs) of 1.16 (U.K. tariffs) and 1.52 (U.S. tariffs) in the CamAPS FX subgroup. Estimated ICERs for the subgroup were £19 324/QALY (United Kingdom) and −$3917/QALY (United States). For subgroup patients already using continuous glucose monitors (CGM), ICERs were £10 096/QALY (United Kingdom) and −$33 616/QALY (United States). Probabilistic sensitivity analysis generated mean ICERs of £19 342/QALY (95% CI: £15 903/QALY to £22 929/QALY) (United Kingdom) and −$28 283/QALY (95% CI: −$59 607/QALY to $1858/QALY) (United States). Conclusions: For children and adolescents with T1D on insulin pump therapy, AID using the Cambridge algorithm appears cost-effective below a £20 000/QALY threshold (United Kingdom) and cost saving (United States).

Funder

National Institute of Diabetes and Digestive and Kidney Diseases

NIHR Cambridge Biomedical Research Centre

Publisher

SAGE Publications

Link

https://journals.sagepub.com/doi/pdf/10.1177/19322968241231950

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