Budget Impact of Advanced Insulin Delivery Systems for the Management of Type 1 Diabetes

Objective: Type 1 diabetes (T1D) affects around 3 million people across Europe. Despite insulin therapy, T1D can lead to diabetic ketoacidosis (DKA), microvascular and macrovascular complications, hypoglycemia, and increased mortality, placing a substantial financial burden on European health care systems. Advances in automated insulin delivery (AID) systems have shown promise in improving glycemic control. This study evaluated the affordability of AID systems compared with standard of care (multiple daily insulin [MDI] injections with intermittently scanned continuous glucose monitoring [isCGM]) by examining the budgetary impact of improved glycemic control and reduced complication rates across nine European countries. Methods: The model estimated the impact of T1D complications on health care costs over a 5-year time horizon, using a hypothetical cohort of 100 individuals with T1D. Two distinct populations were considered based on baseline glycemic control: those with HbA1c ≥8% and those with HbA1c <8%. The model simulated the annual incidence and progression of chronic complications and two acute complications. Incidence rates were driven by HbA1c levels, which varied by treatment and baseline population. Severe hypoglycemia events (SHEs) were modeled separately using treatment- and population-specific rates. A treatment-neutral price was assumed, with country-specific costs applied to complications. Results: The AID system substantially reduced complication rates compared with MDI with isCGM. Among individuals with HbA1c ≥8%, overall complications declined by 61%, including a ∼70% reduction in DKA, resulting in per-person 5-year cost savings ranging from €1595 to €2810 across the modeled countries. In those with HbA1c <8%, complications excluding SHEs fell by 26%; DKA was reduced by approximately 34%, and SHEs were eliminated, translating to per-person savings of €508 to €2819 over 5 years. Conclusion: This analysis highlights the health care budget that could be freed up through the use of AID systems, enabling decision-makers to improve glycemic control in people with T1D without increasing total expenditure.