Cost-effectiveness of health technologies in adults with type 1 diabetes: a systematic review and narrative synthesis

Abstract

Background: With the rapid development of technologies for type 1 diabetes, economic evaluations are integral in guiding cost-effective clinical and policy decisions. We therefore aimed to review and synthesise the current economic literature for available diabetes management technologies and outline key determinants of costeffectiveness. Methods: A systematic search was conducted in April 2019 that focused on modelling or trial based economic evaluations. Searched databases included Medline, Medline in-process and other non-indexed citations, EMBASE, PubMed, All Evidenced Based Medicine Reviews, EconLit, Cost-effectiveness analysis Registry, Research Papers in Economics, Web of Science, PsycInfo, CINAHL, and PROSPERO from inception. We assessed quality of included studies with the Questionnaire to Assess Relevance and Credibility of Modeling Studies for Informing Health Care Decision Making an ISPOR-AMCP-NPC good practice task force report. Screening of abstracts and full-texts, appraisal, and extraction were performed by two independent researches. Results: We identified 16,772 publications, of which 35 were analysed and included 11 health technologies. Despite a lack of consensus, most studies reported that insulin pumps (56%) or interstitial glucose sensors (62%) were costeffective, although incremental cost-effectiveness ratios ranged widely ($14,266-$2,997,832 USD). Cost-effectiveness for combined insulin pumps and glucose sensors was less clear. Determinants of cost-effectiveness included treatment effects on glycosylated haemoglobin and hypoglycaemia, costing of technologies and complications, and measures of utility. Conclusions: Insulin pumps or glucose sensors appeared cost-effective, particularly in populations with higher HbA1c levels and rates of hypoglycaemia. However, cost-effectiveness for combined insulin pumps and glucose sensors was less clear. Registration: The study was registered with PROSPERO, number CRD42017077221.

American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus

“…The most recent systematic review covering the cost-effectiveness of diabetes technology reported that integrated insulin pump systems with LGS were more cost-effective than CSII with SMBG for 8 of 10 of the relevant studies included in the 2020 systematic review. 96 Although cost analyses have not been conducted on PLGS systems, several studies have shown reductions in hypoglycemia, particularly at night, similar to results shown in LGS studies. Pooled estimates from a recent meta-analysis showed that overnight periods of PLGS use were associated with an 8.8% lower risk of nocturnal hypoglycemia than non-PLGS use, which would likely lead to significantly reduced costs.…”

“…74 Today's more advanced integrated systems with LGS, PLGS, and HCL technologies have demonstrated both clinical efficacy and cost-effectiveness in T1D compared with insulin pump therapy alone due to improved glycemic control and reductions in hypoglycemia. 72,75,77,80,81,95,96 A 2019 cost-effectiveness model among 2 T1D cohorts in the Netherlands showed that among participants with suboptimal glycemic control, LGS improved qualityadjusted life expectancy by 1.77 QALYs versus insulin pump therapy alone, with higher lifetime costs (EUR 189 855 vs EUR 150 366), resulting in an ICER of EUR 22 325 per QALY gained 81 For those with an increased risk for hypoglycemia, the use of the system was associated with a 2.16 increase in QALYs with higher lifetime costs (EUR 204 013 vs EUR 171 032), leading to an ICER of EUR 15 243 per QALY gained. 81 The investigators concluded that among individuals with suboptimal glycemic control and/or higher risk for hypoglycemia, switching from CSII without CGM to an integrated system with LGS is cost-effective and will likely result in long-term clinical gains.…”

Technologies for Diabetes Self-Monitoring: A Scoping Review and Assessment Using the REASSURED Criteria

“…In the case of affordability, there are only a limited number of cost-effectiveness studies and health technology assessments that have been conducted mostly in high-income countries. [60][61][62][63] Given that prices and the cutoff point to call a tool "cost-effective" vary between countries we cannot use the available information to assess the REASSURED criteria when thinking about resource constrains settings. One suggestion would be to have an open repository to publicly publish costs of the devices in different countries to be able to estimate the cost-effectiveness of each device per country.…”

Standardizing Reporting of Glucose and Insulin Data for Patients on Multiple Daily Injections Using Connected Insulin Pens and Continuous Glucose Monitoring

“…When a person is utilizing insulin pump therapy, the average annual cost for diabetes care increases substantially. 3,[10][11][12][13][14][15] In countries with advanced economies, this financial burden often weighs most heavily on socioeconomically disadvantaged and vulnerable populations. 5,6,16,17 These financial burdens are an even greater concern for people in emerging economies such as India and China that account for >50% of people with diabetes globally.…”