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
Authors' conclusion
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).
Study context
- Population
- Insulin pump-using children and adolescents aged 6 to 18 years with T1D
- Participants
- 133 children
- Comparison
- Cambridge hybrid closed-loop automated insulin delivery (AID) vs usual care
- AIDn = 65
- Usual caren = 68reference
- Primary endpoint
- Incremental cost-effectiveness ratio (ICER) of AID vs usual care
Methodological detailsmulticenter, binational, parallel-controlled, within-trial and lifetime analysis, Sheffield T1D policy model
- Multicenter
- Binational
- Parallel-controlled
- Within-trial and lifetime analysis
- Sheffield T1D policy model
Primary result
As reported in the abstract
ICER (United Kingdom)
£19 324/QALY
ICER (United States)
-$3917/QALY
Further findings
Health-related quality of life · within-trial
- Both groups had indistinguishable and statistically unchanged health-related quality of life
Total health care utilization · within-trial
- Total health care utilization was higher in the treatment group
HbA1c change, overall treatment group · 6 months
- Improved HbA1c in the overall treatment group
- −0.32%, 95% CI: −0.59 to −0.04; P = .02
HbA1c change, CamAPS FX subgroup · 6 months
- Improved HbA1c in the CamAPS FX subgroup
- −1.05%, 95% CI: −1.43 to −0.67; P < .001
Modelled lifetime outcomes, CamAPS FX subgroup
- Projected increase in expected lifespan
- 5.36 years
- Discounted quality-adjusted life years (QALYs) gained (UK tariffs)
- 1.16
- Discounted QALYs gained (US tariffs)
- 1.52
- Sheffield T1D policy model
ICER, CamAPS FX subgroup already using continuous glucose monitors (CGM) · lifetime
- ICER (UK)
- £10 096/QALY
- ICER (US)
- -$33 616/QALY
Probabilistic sensitivity analysis, mean ICER · lifetime
- Mean ICER (UK)
- £19 342/QALY (95% CI: £15 903/QALY to £22 929/QALY)
- Mean ICER (US)
- -$28 283/QALY (95% CI: -$59 607/QALY to $1858/QALY)
Safety
Hypoglycemia, severe hypoglycemia and diabetic ketoacidosis (DKA) (within-trial)
- Statistically similar hypoglycemia, severe hypoglycemia and DKA event rates
Original publication
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