1. |
- Roze, S., et al.
(author)
-
Health-economic analysis of real-time continuous glucose monitoring in people with Type 1 diabetes
- 2015
-
In: Diabetic Medicine. - : Wiley. - 0742-3071 .- 1464-5491. ; 32:5, s. 618-626
-
Journal article (peer-reviewed)abstract
- Aim: To evaluate the clinical benefits and cost-effectiveness of the sensor-augmented pump compared with self-monitoring of plasma glucose plus continuous subcutaneous insulin infusion in people with Type 1 diabetes.Methods: The CORE Diabetes Model was used to simulate disease progression in a cohort of people with baseline characteristics taken from a published meta-analysis. Direct and indirect costs for 2010-2011 were calculated from a societal payer perspective, with cost-effectiveness calculated over the patient's lifetime. Discount rates of 3% per annum were applied to the costs and the clinical outcomes.Results: Use of the sensor-augmented pump was associated with an increase in mean discounted, quality-adjusted life expectancy of 0.76 quality-adjusted life years compared with continuous subcutaneous insulin infusion (13.050.12 quality-adjusted life years vs 12.290.12 quality-adjusted life years, respectively). Undiscounted life expectancy increased by 1.03years for the sensor-augmented pump compared with continuous subcutaneous insulin infusion. In addition, the onset of complications was delayed (by a mean of 1.15years) with use of the sensor-augmented pump. This analysis resulted in an incremental cost-effectiveness ratio of 367,571 SEK per quality-adjusted life year gained with the sensor-augmented pump. The additional treatment costs related to the use of the sensor-augmented pump were partially offset by the savings attributable to the reduction in diabetes-related complications and the lower frequency of self-monitoring of plasma glucose.Conclusions: Analysis using the CORE Diabetes Model showed that improvements in glycaemic control associated with sensor-augmented pump use led to a reduced incidence of diabetes-related complications and a longer life expectancy. Use of the sensor-augmented pump was associated with an incremental cost-effectiveness ratio of 367,571 SEK per quality-adjusted life year gained, which is likely to represent good value for money in the treatment of Type 1 diabetes in Sweden.What's new? This study builds on a recent meta-analysis to provide further insights into the clinical and safety aspects of real-time continuous glucose monitoring. Simulations of disease progression show how these aspects translate into long-term patient benefits and healthcare costs. Simulations indicate that continuous glucose monitoring leads to later onset and reduced incidence of acute and long-term diabetes-related complications. The findings may have an important influence on informing treatment choices with respect to providing value both for patients and healthcare payers.
|
|
2. |
|
|
3. |
|
|
4. |
|
|
5. |
|
|
6. |
- Jendle, Johan, 1963-, et al.
(author)
-
The Cost-Effectiveness of an Advanced Hybrid Closed-Loop System in People with Type 1 Diabetes : a Health Economic Analysis in Sweden
- 2021
-
In: Diabetes Therapy. - : Springer. - 1869-6953 .- 1869-6961. ; 12:11, s. 2977-2991
-
Journal article (peer-reviewed)abstract
- INTRODUCTION: Swedish National Diabetes Registry data show a correlation of improved glycemic control in people with type 1 diabetes (T1D) with increased use of diabetes technologies over the past 25 years. However, novel technologies are often associated with a high initial outlay. The aim of the present study was to evaluate the long-term cost-effectiveness of the advanced hybrid closed-loop (AHCL) MiniMed 780G system versus intermittently scanned continuous glucose monitoring (isCGM) plus self-injection of multiple daily insulin (MDI) or continuous subcutaneous insulin infusion (CSII) in people with T1D in Sweden.METHODS: Outcomes were projected over patients' lifetimes using the IQVIA CORE Diabetes Model (v9.0). Clinical data, including changes in glycated hemoglobin (HbA1c) and hypoglycemia rates, were sourced from observational studies and a randomized crossover trial. Modeled patients were assumed to receive the treatments for their lifetimes, with HbA1c kept constant following the application of treatment effects. Costs were accounted from a societal perspective and expressed in Swedish krona (SEK). Utilities and days off work estimates were taken from published sources.RESULTS: The MiniMed 780G system was associated with an improvement in life expectancy of 0.16 years and an improvement in quality-adjusted life expectancy of 1.95 quality-adjusted life years (QALYs) versus isCGM plus MDI or CSII. These clinical benefits were due to a reduced incidence and a delayed time to onset of diabetes-related complications. Combined costs were estimated to be SEK 727,408 (EUR 72,741) higher with MiniMed 780G, with treatment costs partially offset by direct cost savings from the avoidance of diabetes-related complications and indirect cost savings from the avoidance of lost workplace productivity. The MiniMed 780G system was associated with an incremental cost-effectiveness ratio of SEK 373,700 per QALY gained.CONCLUSIONS: Based on a willingness-to-pay threshold of SEK 500,000 per QALY gained, the MiniMed 780G system was projected to be cost-effective versus isCGM plus MDI or CSII for the treatment of T1D in Sweden.
|
|
7. |
- Roze, S., et al.
(author)
-
Cost-effectiveness of sensor-augmented pump therapy versus standard insulin pump therapy in patients with type 1 diabetes in Denmark
- 2017
-
In: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227. ; 128, s. 6-14
-
Journal article (peer-reviewed)abstract
- Aims The use of continuous subcutaneous insulin infusion (CSII) in type 1 diabetes (T1D) has increased in recent years. Sensor-augmented pump therapy (SAP) with low glucose suspend (LGS) (allowing temporary suspension of insulin delivery if blood glucose level falls below a pre-defined threshold level) provides additional benefits over CSII alone, but is associated with higher acquisition costs. Therefore, a cost-effectiveness analysis of SAP + LGS versus CSII in patients with T1D was performed. Methods Analyses were performed using the CORE Diabetes Model in two different patient cohorts in Denmark, one with hyperglycemia at baseline and one with increased risk for hypoglycemic events. Clinical input data were sourced from published literature. The analysis was performed over a lifetime time horizon from a societal perspective. Future costs and clinical outcomes were discounted at 3% per annum. Results In patients who were hyperglycemic at baseline the use of SAP + LGS versus CSII resulted in improved quality-adjusted life expectancy (12.44 versus 10.99 quality-adjusted life years [QALYs]) but higher mean lifetime costs (DKK 2,027,316 versus DKK 1,801,293) leading to an incremental cost-effectiveness ratio (ICER) of DKK 156,082 per QALY gained. For patients at increased risk for hypoglycemic events the ICER for SAP + LGS versus CSII was DKK 89,868 per QALY gained. Conclusions The ICER for SAP + LGS versus CSII falls below commonly cited willingness-to-pay thresholds. Therefore, in Denmark, the use of SAP + LGS is likely to be considered cost-effective relative to CSII for patients with T1D who are either hyperglycemic, despite CSII use, or who experience frequent severe hypoglycemic events.
|
|
8. |
- Roze, S., et al.
(author)
-
Health-Economic Analysis Of The Use Of Sensor-Augmented Pump With Predictive Suspend Function (Sap) Therapy In Sweden Compared To Insulin Pump Therapy Alone (Csii), In Type 1 Diabetic Patients
- 2016
-
In: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 19:7, s. A699-A699
-
Journal article (peer-reviewed)abstract
- Objectives: To assess the cost-effectiveness and to project the clinical benefits of sensor augmented pump (SAP) compared to continuous subcutaneous insulin infu-sion therapy (CSII), in Swedish type 1 diabetic patients (T1D).Methods: The Core Diabetes Model is a simulation model to determine the long-term health economic outcomes of diabetes interventions. It was used to project the incidence of diabetes-related complications over a lifetime horizon, based on a) a meta-analysis compar-ing SAP versus CSII for the uncontrolled T1D population and b) on a randomized trial for the hypo-unaware population. The meta-analysis showed that for the cohort based on the Swedish registry NDR 2014, with a mean HbA1c of 63.14 mmol/mol, age of 46 years and a diabetes duration of 24-years led to a reduction of -0.58% versus -0.14% HbA1c, for SAP and CSII respectively. In the hypo-unaware popula-tion severe hypoglycemic events were observed at 2.2 per 100 patient’s months and 0 for CSII and SAP respectively.Results: The incremental cost-effectiveness ratio (ICER) was 251’896 SEK per Quality Adjusted Life Year gained (QALY) based on a societal perspective for the uncontrolled population. In the hypo-unaware population the ICER was 139’795 SEK/QALY. The improvement in QALYs were 1.07 and 1.88 years in favor of SAP in the uncontrolled and hypo-unaware population respectively. Additional related costs were partially offset by the savings due to the reduction in complications. Delay of onset of complications were achieved with SAP compared to CSII alone, such as neuropathy (1.04 years), ulcer (0.92 years) and stroke (0.64 years).Conclusions: These results indicate that accordingly to commonly accepted threshold in Sweden, SAP with predictive suspend function compared to CSII alone can be considered as good value for money in T1D both indications: uncontrolled and hypo-unaware. Extensive sensitivity analysis on key drivers confirmed the robustness of results.
|
|
9. |
|
|