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

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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.

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