American Diabetes Association
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The cost of control: Cost-effectiveness analysis of hybrid closed-loop therapy in youth

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posted on 2022-07-01, 09:21 authored by Anthony Pease, Emily Callander, Ella Zomer, Mary B Abraham, Elizabeth A Davis, Timothy W Jones, Danny Liew, Sophia Zoungas


Objective: Hybrid closed-loop (HCL) therapy is an efficacious management strategy for young people with type 1 diabetes. However, high costs prevent equitable access. We thus sought to evaluate the cost-effectiveness of HCL therapy in comparison to current care among young people with type 1 diabetes in Australia. 

Methods: A patient-level Markov model was constructed to simulate disease progression for young people with type 1 diabetes using HCL therapy versus current care, with follow-up from 12 until 25 years of age. Downstream health and economic consequences were compared via decision analysis. Treatment-effects and proportions using different technologies to define ‘current care’ were based primarily on data from an Australian pediatric randomized controlled trial. Transition probabilities and utilities for health states were sourced from published studies. Costs were considered from the Australian healthcare system’s perspective. An annual discount rate of 5% was applied to future costs and outcomes. Uncertainty was evaluated with probabilistic and deterministic sensitivity analyses.

Results: Use of HCL therapy resulted in an incremental cost-effectiveness ratio (ICER) of Australian Dollars (AUD) $32,789 per quality adjusted life year (QALY) gained. The majority of simulations (93.3%) were below the commonly accepted willingness-to-pay threshold of AUD $50,000 per QALY gained in Australia. Sensitivity analyses indicated that the base-case results were robust. 

Conclusions: In this first cost-effectiveness analysis of HCL technologies for the management of young people with type 1 diabetes, HCL therapy was found to be cost-effective when compared to current care in Australia.


This economic evaluation was developed through collaborations as part of the Juvenile Diabetes Research Foundation (JDRF) Global Centre of Excellence in diabetes research. Funding and support for the randomized controlled trial, ‘Effect of a hybrid closed-loop system on glycemic and psychosocial outcomes in children and adolescents with type 1 diabetes: a randomized clinical trial’ comprised: grant 4-SRA-2016-350-M-B from the Juvenile Diabetes Research Fund Australia Type 1 Diabetes Clinical Research Network (Dr Jones), grant APP1078190 from a Special Research Initiative of the Australian National Health and Medical Research Council (Dr Jones), and grant 9729 from the PCH Foundation (Dr Jones). The National Health and Medical Research Council Clinical Trials Centre was supported by its National Health and Medical Research Council Program grant. In-kind support was provided by Medtronic through the provision of insulin pumps, sensors, and transmitters for the study. Roche Diabetes Care provided the glucometers for the study. JDRF Australia provided input into the study design. The funders of the trial had no role in collection, analysis, and interpretation of the data and in manuscript preparation. For the randomized controlled trial, MBA was supported by the Department of Health/Raine Clinical Research Fellowship from Western Australia.