Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
Medtronic Diabetes, Northridge, California, USA.
Diabetes Technol Ther. 2024 May;26(5):324-334. doi: 10.1089/dia.2023.0455. Epub 2024 Mar 22.
Despite advances in technology, glycemic outcomes in people with type 1 diabetes (T1D) remain suboptimal. The MiniMed 780G (MM780G) advanced hybrid closed-loop (AHCL) system is the latest technology for T1D management with established safety and efficacy. This study explores the cost-effectiveness of MM780G AHCL compared against multiple daily injections (MDI) plus intermittently scanned continuous glucose monitor (isCGM). A cost-utility analysis was conducted, simulating lifetime outcomes for 1000 T1D individuals, with baseline hemoglobin A1c of 8.4%, using the IQVIA Core Diabetes Model (CDM) v9.5. A Singapore health care payer perspective was taken with 2023 costs applied. Treatment effects were taken from the ADAPT study and treatment-related events from a combination of sources. T1D complication costs were derived from local literature, and health state utilities and disutilities from published literature. Scenario analyses and probabilistic sensitivity analyses (PSAs) explored uncertainty. Cost-effectiveness was assessed based on willingness-to-pay (WTP) thresholds set to Singapore Dollars (SGD) 45,000 (United States Dollars [USD] 33,087) per quality-adjusted life year (QALY) and Singapore's gross domestic product (GDP) per capita of SGD 114,165 (USD 83,941) per QALY. A switch from MDI plus isCGM to MM780G resulted in expected gains in life-years (+0.78) and QALYs (+1.45). Cost savings through reduction in T1D complications (SGD 25,465; USD 18,723) partially offset the higher treatment costs in the AHCL arm (+SGD 74,538; +USD 54,805), resulting in an estimated incremental cost-effectiveness ratio of SGD 33,797 (USD 24,850) per QALY gained. Findings were robust, with PSA outputs indicating 81% and 99% probabilities of cost-effectiveness at the stated WTP thresholds. MM780G is a cost-effective option for people with T1D managed in a Singapore setting.
尽管技术不断进步，但 1 型糖尿病（T1D）患者的血糖控制结果仍不尽人意。MiniMed 780G（MM780G）高级混合闭环（AHCL）系统是 T1D 管理的最新技术，具有既定的安全性和有效性。本研究探讨了 MM780G AHCL 与多次每日注射（MDI）加间歇性扫描连续血糖监测（isCGM）相比的成本效益。采用 IQVIA 核心糖尿病模型（CDM）v9.5 对 1000 名 T1D 个体进行了终生模拟，这些个体的基线糖化血红蛋白（HbA1c）为 8.4%，进行了成本效用分析。采用新加坡医疗保健支付者视角，采用 2023 年成本。治疗效果取自 ADAPT 研究，治疗相关事件取自多个来源。T1D 并发症成本来自当地文献，健康状态效用和失效率来自已发表文献。情景分析和概率敏感性分析（PSA）探讨了不确定性。基于愿意支付（WTP）的新加坡元（SGD）45000（美元 33087）每质量调整生命年（QALY）和新加坡人均国内生产总值（GDP）的 SGD 114165（美元 83941）每 QALY 的阈值，评估了成本效益。从 MDI 加 isCGM 转换为 MM780G 预计会增加生命年（+0.78）和 QALYs（+1.45）。通过减少 T1D 并发症（SGD 25465；美元 18723）而节省的成本部分抵消了 AHCL 臂中较高的治疗成本（+SGD 74538；+USD 54805），估计增量成本效益比为每获得一个 QALY 需花费 SGD 33797（USD 24850）。结果是稳健的，PSA 结果表明，在规定的 WTP 阈值下，成本效益的概率分别为 81%和 99%。对于在新加坡环境下管理的 T1D 患者，MM780G 是一种具有成本效益的选择。
