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      The Cost-Effectiveness of an Advanced Hybrid Closed-Loop System Compared to Standard Management of Type 1 Diabetes in a Singapore Setting

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          Abstract

          Background:

          Despite advances in technology, glycemic outcomes in people with type 1 diabetes (T1D) remain suboptimal. The MiniMed 780G (MM780G) advanced hybrid closed-loop (AHCL) system is the latest technology for T1D management with established safety and efficacy. This study explores the cost-effectiveness of MM780G AHCL compared against multiple daily injections (MDI) plus intermittently scanned continuous glucose monitor (isCGM).

          Methods:

          A cost-utility analysis was conducted, simulating lifetime outcomes for 1000 T1D individuals, with baseline hemoglobin A1c of 8.4%, using the IQVIA Core Diabetes Model (CDM) v9.5. A Singapore health care payer perspective was taken with 2023 costs applied. Treatment effects were taken from the ADAPT study and treatment-related events from a combination of sources. T1D complication costs were derived from local literature, and health state utilities and disutilities from published literature. Scenario analyses and probabilistic sensitivity analyses (PSAs) explored uncertainty. Cost-effectiveness was assessed based on willingness-to-pay (WTP) thresholds set to Singapore Dollars (SGD) 45,000 (United States Dollars [USD] 33,087) per quality-adjusted life year (QALY) and Singapore's gross domestic product (GDP) per capita of SGD 114,165 (USD 83,941) per QALY.

          Results:

          A switch from MDI plus isCGM to MM780G resulted in expected gains in life-years (+0.78) and QALYs (+1.45). Cost savings through reduction in T1D complications (SGD 25,465; USD 18,723) partially offset the higher treatment costs in the AHCL arm (+SGD 74,538; +USD 54,805), resulting in an estimated incremental cost-effectiveness ratio of SGD 33,797 (USD 24,850) per QALY gained. Findings were robust, with PSA outputs indicating 81% and 99% probabilities of cost-effectiveness at the stated WTP thresholds.

          Conclusion:

          MM780G is a cost-effective option for people with T1D managed in a Singapore setting.

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          Most cited references52

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          Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

          Tadej Battelino, Thomas Danne, Richard M. Bergenstal … (2019)
          Improvements in sensor accuracy, greater convenience and ease of use, and expanding reimbursement have led to growing adoption of continuous glucose monitoring (CGM). However, successful utilization of CGM technology in routine clinical practice remains relatively low. This may be due in part to the lack of clear and agreed-upon glycemic targets that both diabetes teams and people with diabetes can work toward. Although unified recommendations for use of key CGM metrics have been established in three separate peer-reviewed articles, formal adoption by diabetes professional organizations and guidance in the practical application of these metrics in clinical practice have been lacking. In February 2019, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress convened an international panel of physicians, researchers, and individuals with diabetes who are expert in CGM technologies to address this issue. This article summarizes the ATTD consensus recommendations for relevant aspects of CGM data utilization and reporting among the various diabetes populations.
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            State of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016–2018

            Nicole C Foster, Roy Beck, Kellee Miller … (2019)
            To provide a snapshot of the profile of adults and youth with type 1 diabetes (T1D) in the United States and assessment of longitudinal changes in T1D management and clinical outcomes in the T1D Exchange registry.
            Article 0 comments Cited 512 times – based on 0 reviews     Review now
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              Effect of Continuous Glucose Monitoring on Glycemic Control in Adults With Type 1 Diabetes Using Insulin Injections: The DIAMOND Randomized Clinical Trial.

              Roy Beck, Tonya Riddlesworth, Katrina Ruedy … (2017)
              Previous clinical trials showing the benefit of continuous glucose monitoring (CGM) in the management of type 1 diabetes predominantly have included adults using insulin pumps, even though the majority of adults with type 1 diabetes administer insulin by injection.
              Article 0 comments Cited 288 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Diabetes Technol Ther
                Journal ID (iso-abbrev): Diabetes Technol Ther
                Journal ID (publisher-id): dia
                Title: Diabetes Technology & Therapeutics
                Publisher: Mary Ann Liebert, Inc., publishers (140 Huguenot Street, 3rd Floor New Rochelle, NY 10801 USA )
                ISSN (Print): 1520-9156
                ISSN (Electronic): 1557-8593
                Publication date (Print): May 2024
                Publication date (Electronic): 30 April 2024
                Publication date PMC-release: 30 April 2024
                Volume: 26
                Issue: 5
                Pages: 324-334
                Affiliations
                [ 1 ]Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
                [ 2 ]Medtronic Diabetes, Northridge, California, USA.
                [ 3 ]Medtronic Singapore, Singapore, Singapore.
                Author notes

                Data from the manuscript were shared at the American Diabetes Association 83rd Scientific Sessions | San Diego, California | June 23rd to 26th, 2023 | 1009-P.

                [*]Address correspondence to: Daphne Gardner, MA, BMBCh(Oxon), MRCP(UK), Department of Endocrinology, Singapore General Hospital, 20 College Road, Singapore 169856, Singapore daphne.gardner@ 123456singhealth.com.sg

                iORCID ID ( https://orcid.org/0009-0006-8884-839X).

                iiORCID ID ( https://orcid.org/0000-0001-5944-4886).

                Author information
                https://orcid.org/0009-0006-8884-839X
                https://orcid.org/0000-0001-5944-4886
                Article
                Publisher ID: 10.1089/dia.2023.0455
                DOI: 10.1089/dia.2023.0455
                PMC ID: 11058413
                PubMed ID: 38215206
                SO-VID: 7ef33060-67d9-4e85-b8b6-04006bc989bf
                Copyright © © Daphne Gardner, et al., 2024; Published by Mary Ann Liebert, Inc.
                License:

                This Open Access article is distributed under the terms of the Creative Commons License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

                History
                Page count
                Figures: 2, Tables: 4, References: 68, Pages: 11
                Categories
                Subject: Original Articles

                Keywords: advanced hybrid closed-loop system,cost-effectiveness,cost of days off work,type 1 diabetes,singapore
                Data availability:
                Keywords: advanced hybrid closed-loop system, cost-effectiveness, cost of days off work, type 1 diabetes, singapore

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