Abstract
BackgroundWith the rapid development of technologies for type 1 diabetes, economic evaluations are integral in guiding cost-effective clinical and policy decisions. We therefore aimed to review and synthesise the current economic literature for available diabetes management technologies and outline key determinants of cost-effectiveness.MethodsA systematic search was conducted in April 2019 that focused on modelling or trial based economic evaluations. Searched databases included Medline, Medline in-process and other non-indexed citations, EMBASE, PubMed, All Evidenced Based Medicine Reviews, EconLit, Cost-effectiveness analysis Registry, Research Papers in Economics, Web of Science, PsycInfo, CINAHL, and PROSPERO from inception. We assessed quality of included studies with the Questionnaire to Assess Relevance and Credibility of Modeling Studies for Informing Health Care Decision Making an ISPOR-AMCP-NPC good practice task force report. Screening of abstracts and full-texts, appraisal, and extraction were performed by two independent researches.ResultsWe identified 16,772 publications, of which 35 were analysed and included 11 health technologies. Despite a lack of consensus, most studies reported that insulin pumps (56%) or interstitial glucose sensors (62%) were cost-effective, although incremental cost-effectiveness ratios ranged widely ($14,266–$2,997,832 USD). Cost-effectiveness for combined insulin pumps and glucose sensors was less clear. Determinants of cost-effectiveness included treatment effects on glycosylated haemoglobin and hypoglycaemia, costing of technologies and complications, and measures of utility.ConclusionsInsulin pumps or glucose sensors appeared cost-effective, particularly in populations with higher HbA1c levels and rates of hypoglycaemia. However, cost-effectiveness for combined insulin pumps and glucose sensors was less clear.RegistrationThe study was registered with PROSPERO, number CRD42017077221.
Highlights
With the rapid development of technologies for type 1 diabetes, economic evaluations are integral in guiding cost-effective clinical and policy decisions
Most studies in our network reported that newer diabetes management technologies were cost-effective Incremental cost effectiveness ratio (ICER) varied widely
Insulin pumps or glucose sensors appeared cost-effective, especially in populations with the most to gain from such interventions such as those with higher HbA1c levels and rates of hypoglycaemia
Summary
With the rapid development of technologies for type 1 diabetes, economic evaluations are integral in guiding cost-effective clinical and policy decisions. We aimed to review and synthesise the current economic literature for available diabetes management technologies and outline key determinants of costeffectiveness. Advanced technologies have been developed over the last 40 to 50 years to improve glycaemia and prevent complications of diabetes [4, 5]. The uptake of these devices for insulin delivery, glucose sensing, and insulin-dose advice is growing internationally [6,7,8,9]. Funding options for these management devices in some settings may prevent patients from accessing treatment regardless of the potential clinical benefit [10,11,12]
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