Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2025
Clinical and Economic Impact of Hybrid Closed-Loop Systems for T1 Diabetes Management in Spain.
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Khan-Mirón Aesha, Syleouni Maria-Eleni, Brusaferri Giovanni, Nyffeler Myriel, Chico Ana, Moreno-Fernández Jesús, Beato-Víbora Pilar I
Аннотация
OBJECTIVE: The main challenge in type 1 diabetes mellitus management is achieving and maintaining glycemic control. Hybrid closed-loop (HCL) systems offer patients the potential to safely achieve tight glycemic targets. This study analyzed the clinical and economic impact of HCL systems compared with intermittently scanned continuous glucose monitoring (is-CGM) and continuous subcutaneous insulin infusion (CSII) therapy from the Spanish health care system perspective.
METHODS: IQVIA Core Diabetes Model v10.0 was used to simulate a cohort of 1000 individuals assigned to either the HCL or is-CGM+CSII therapy. Different time horizons were analyzed: 5, 15, 30, and 50 years. Cohort characteristics were extracted from published literature, and a 1.5% glycated hemoglobin A1C reduction was considered for the HCL group over is-CGM+CSII.
RESULTS: In the HCL group, complications were averted or delayed across all time horizons whereas survival, quality of life, and cost savings were increased. At 50 years, HCL group survival was double than the comparator and 1.15 incremental quality-adjusted life years were gained. Cost savings were the highest at 50 years (28 704 922€/1000 individuals) mostly attributable to lower amputation, ulcer, and nephrological event rates. The current study is based on real-world evidence data with a median follow-up of 5.1 months. Thus, the long-term projections of clinical and economic outcomes may be affected by uncertainty. Additionally, the study did not include any hypoglycemia or diabetic ketoacidosis rates, which may lead to underestimation of the real impact of HCL systems.
CONCLUSION: HCL systems should be considered the primary treatment option compared with is-CGM+CSII therapy for people with type 1 diabetes mellitus in Spain.
METHODS: IQVIA Core Diabetes Model v10.0 was used to simulate a cohort of 1000 individuals assigned to either the HCL or is-CGM+CSII therapy. Different time horizons were analyzed: 5, 15, 30, and 50 years. Cohort characteristics were extracted from published literature, and a 1.5% glycated hemoglobin A1C reduction was considered for the HCL group over is-CGM+CSII.
RESULTS: In the HCL group, complications were averted or delayed across all time horizons whereas survival, quality of life, and cost savings were increased. At 50 years, HCL group survival was double than the comparator and 1.15 incremental quality-adjusted life years were gained. Cost savings were the highest at 50 years (28 704 922€/1000 individuals) mostly attributable to lower amputation, ulcer, and nephrological event rates. The current study is based on real-world evidence data with a median follow-up of 5.1 months. Thus, the long-term projections of clinical and economic outcomes may be affected by uncertainty. Additionally, the study did not include any hypoglycemia or diabetic ketoacidosis rates, which may lead to underestimation of the real impact of HCL systems.
CONCLUSION: HCL systems should be considered the primary treatment option compared with is-CGM+CSII therapy for people with type 1 diabetes mellitus in Spain.