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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.
Fox, D Steven; Ware, Julia; Boughton, Charlotte K; Allen, Janet M; Wilinska, Malgorzata E; Tauschmann, Martin; Denvir, Louise; Thankamony, Ajay; Campbell, Fiona; Wadwa, R Paul; Buckingham, Bruce A; Davis, Nikki; DiMeglio, Linda A; Mauras, Nelly; Besser, Rachel E J; Ghatak, Atrayee; Weinzimer, Stuart A; Kanapka, Lauren; Kollman, Craig; Sibayan, Judy; Beck, Roy W; Hood, Korey K; Hovorka, Roman.
Affiliation
  • Fox DS; Department of Pharmaceutical and Health Economics, Mann School of Pharmacy, University of Southern California, Los Angeles, CA, USA.
  • Ware J; Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
  • Boughton CK; Department of Paediatrics, University of Cambridge, Cambridge, UK.
  • Allen JM; Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
  • Wilinska ME; Department of Diabetes & Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
  • Tauschmann M; Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
  • Denvir L; Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
  • Thankamony A; Department of Paediatrics, University of Cambridge, Cambridge, UK.
  • Campbell F; Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
  • Wadwa RP; Department of Paediatrics, University of Cambridge, Cambridge, UK.
  • Buckingham BA; Department of Paediatric Diabetes and Endocrinology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
  • Davis N; Department of Paediatrics, University of Cambridge, Cambridge, UK.
  • DiMeglio LA; Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds, UK.
  • Mauras N; Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
  • Besser REJ; Stanford University School of Medicine, Stanford Diabetes Research Center, Stanford, CA, USA.
  • Ghatak A; Department of Paediatric Endocrinology and Diabetes, Southampton Children's Hospital, Southampton General Hospital, Southampton, UK.
  • Weinzimer SA; Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA.
  • Kanapka L; Nemours Children's Health, Jacksonville, FL, USA.
  • Kollman C; Oxford University Hospitals NHS Foundation Trust, NIHR Oxford Biomedical Research Centre, Oxford, UK.
  • Sibayan J; Department of Paediatrics, University of Oxford, Oxford, UK.
  • Beck RW; Alder Hey Children's Hospital, Liverpool, UK.
  • Hood KK; Department of Pediatrics, Yale University, New Haven, CT, USA.
  • Hovorka R; The Jaeb Center for Health Research, Tampa, FL, USA.
J Diabetes Sci Technol ; : 19322968241231950, 2024 Mar 17.
Article in En | MEDLINE | ID: mdl-38494876
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).
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Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: J Diabetes Sci Technol Journal subject: ENDOCRINOLOGIA Year: 2024 Document type: Article Affiliation country: United States
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Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: J Diabetes Sci Technol Journal subject: ENDOCRINOLOGIA Year: 2024 Document type: Article Affiliation country: United States