Assessing the economic value of maintained improvements in Type 1 diabetes management, in terms of HbA_1c, weight and hypoglycaemic event incidence

Abstract

AimsInsulin therapy is indicated for people with Type 1 diabetes mellitus; however, treatment‐related weight gain and hypoglycaemia represent barriers to optimal glycaemic management. This study assessed the health economic value of maintained reductions in HbA1c, BMI and hypoglycaemia incidence among the UK Type 1 diabetes population.MethodsThe Cardiff Type 1 Diabetes Model was used to estimate lifetime costs, life‐years and quality‐adjusted life‐years (QALYs) for individuals with Type 1 diabetes at different baseline HbA1c, BMI and hypoglycaemic event rates. Results were discounted at 3.5%, and the net monetary benefit associated with improving Type 1 diabetes management was derived at £20 000/QALY gained. Per‐person outputs were inflated to national levels using UK Type 1 diabetes prevalence estimates.ResultsModelled subjects with an HbA1c of 86 mmol/mol (10.0%) were associated with discounted lifetime per‐person costs of £23 795; £12 649 of which may be avoided by maintaining an HbA1c of 42 mmol/mol (6.0%). Combined with estimated QALY gains of 2.80, an HbA1c of 42 mmol/mol (6.0%) vs. 86 mmol/mol (10.0%) was associated with a £68 621 per‐person net monetary benefit. Over 1 year, unit reductions in BMI produced £120 per‐person net monetary benefit, and up to £197 for the avoidance of one non‐severe hypoglyceamic event.ConclusionsMaintained reductions in HbA1c significantly alleviate the burden associated with Type 1 diabetes in the UK. Given the influence of weight and hypoglycaemia on health economic outcomes, they must also be key considerations when assessing the value of Type 1 diabetes technologies in clinical practice.

Optimizing type 1 diabetes after multiple daily injections and capillary blood monitoring: Pump or sensor first? A meta‐analysis using pooled differences in outcome measures

“…Microvascular complications such as retinopathy, neuropathy and nephropathy, and macrovascular complications such as cardiovascular disease and stroke, make up approximately 70% of the overall National Health Service (NHS) budget for T1D in the UK 4 . Improving glycaemia, targeting individuals at the highest risk and reducing exposure to hypoglycaemia would be the most beneficial approaches to reducing care costs for people with T1D 5 …”

Direct medical costs in the preceding, event and subsequent years of a first severe hypoglycaemia episode requiring hospitalization: A population‐based cohort study

“…Our further analysis of healthcare service utilization found that patients with a history of DM-related complications and an increasing number of comorbidities were associated with greater hospitalization admission rates during the event year. Correspondingly, the increase in direct medical costs was associated with poor glycaemic control, 30 treatment intensification, 31 incidence of DM-related complications 23,32 and all-cause mortality. 22 Annual direct medical costs grew by 95.3% from 2481 US$ during the 2 years preceding the SH event to 4846 US$ during the year immediately preceding the SH.…”

Optimizing the use of technology to support people with diabetes: research recommendations from Diabetes UK’s 2019 diabetes and technology workshop

“…The importance of analysing the health economic and social impacts of the use of technology in diabetes management and prevention was highlighted, particularly in light of the need to demonstrate clear benefit to change NHS policy. Aspects of diabetes technology in need of this type of assessment include the potential for glucose monitoring technology or closed loop systems to prevent poor health outcomes with a major health economic cost through reducing HbA1c 40,41 and the reduction in interrupted sleep for parents of young children with diabetes which glucose monitoring technology can provide. 42…”