在芬兰1型糖尿病儿童和成人的真实环境中，将自动胰岛素输送系统与持续皮下胰岛素输注泵及连续血糖监测进行比较的长期健康经济评估。

Long-term health economic evaluation of automated insulin delivery system compared with continuous subcutaneous insulin infusion pumps and CGM in a real-world setting in Finnish paediatric and adult individuals with type 1 diabetes.

作者信息

Vallivaara Heta-Leena, Leppänen Hanna A, Mustonen Jyrki, Saari Antti, Martikainen Janne, Rintamäki Reeta M

机构信息

School of Medicine, University of Eastern Finland, Kuopio, Finland.

Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland.

出版信息

Diabetes Obes Metab. 2025 Sep;27(9):4793-4801. doi: 10.1111/dom.16520. Epub 2025 Jun 27.

DOI:10.1111/dom.16520

PMID:40574544

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12326945/

Abstract

AIMS

The use of automated insulin delivery (AID) systems is associated with improved glycaemic control in individuals with type 1 diabetes (T1DM). However, AID systems are more expensive than other treatment modalities for T1DM. The aim of this study was to evaluate the long-term cost-effectiveness of AID compared to continuous subcutaneous insulin infusion (CSII) combined with continuous glucose monitoring (CGM) in individuals with T1DM at Kuopio University Hospital, Finland.

MATERIALS AND METHODS

The study included 336 individuals (mean age: 26.7 years, SD: 15.9 years), with a mean duration of diabetes of 16.6 years. Outcomes were projected in the base case of 50 years using the IQVIA CORE Diabetes Model (v10.0). Clinical data were sourced from electronic health records (EHRs), including changes in glycated haemoglobin (HbA1c) and events of hypoglycaemia and ketoacidosis. Costs were expressed in 2023 Euros (EUR).

RESULTS

The AID system was associated with an improvement in quality-adjusted life expectancy of 2.3 quality-adjusted life-years (QALYs) compared to CSII plus CGM. These benefits came from the delayed and reduced incidence of diabetes-related complications. The mean HbA1c improvement was 12.1 ± 11.7 mmol/mol (3.3% ± 3.2%) in the AID group. Direct costs were estimated to be 26 076 EUR higher for AID than for CSII plus CGM, and AID was associated with an incremental cost-effectiveness ratio (ICER) of 11 184 EUR per QALY gained.

CONCLUSIONS

Based on the results of this first cost-effectiveness study conducted in Finland, a willingness-to-pay (WTP) threshold of 50 000 EUR per QALY gained suggests that AID is more cost-effective than CSII plus CGM for the treatment of T1DM in a real-world setting.

摘要

目的

使用自动胰岛素输送（AID）系统与改善1型糖尿病（T1DM）患者的血糖控制相关。然而，AID系统比T1DM的其他治疗方式更昂贵。本研究的目的是评估在芬兰库奥皮奥大学医院，AID与持续皮下胰岛素输注（CSII）联合持续葡萄糖监测（CGM）相比，对T1DM患者的长期成本效益。

材料与方法

该研究纳入了336名个体（平均年龄：26.7岁，标准差：15.9岁），糖尿病平均病程为16.6年。使用IQVIA CORE糖尿病模型（v10.0）在50年的基础病例中预测结果。临床数据来自电子健康记录（EHR），包括糖化血红蛋白（HbA1c）的变化以及低血糖和酮症酸中毒事件。成本以2023欧元（EUR）表示。

结果

与CSII加CGM相比，AID系统使质量调整生命预期提高了2.3个质量调整生命年（QALY）。这些益处来自糖尿病相关并发症发生率的延迟和降低。AID组的平均HbA1c改善为12.1±11.7 mmol/mol（3.3%±3.2%）。估计AID的直接成本比CSII加CGM高26,076欧元，AID每获得一个QALY的增量成本效益比（ICER）为11,184欧元。