Long-Term Clinical and Economic Impact of Automated Insulin Delivery Systems Use in Pediatric and Adolescents Type 1 Diabetes: Results Across Australia, Canada, the UK, and the USA

BACKGROUND AND AIMS: Automated Insulin Delivery (AID) systems are the recommended standard of care for Type 1 Diabetes (T1D) management in children and adolescents, according to latest international guidelines. This study aims to assess the cost-effectiveness of AID systems for pediatric T1D care in Australia, Canada, the United Kingdom (UK), and the United States (USA). MATERIALS AND METHODS: England real-world AID pilot initiative, a prospective follow-up study of 251 children and adolescents with T1D that showed a 0.63% reduction in HbA1c following the first year of system use. Clinical and economic outcomes were analyzed over a 55-year time horizon from a health care system perspective, applying country-specific discount rates and direct costs to estimate cost-effectiveness ratios (ICERs). RESULTS: AID systems were associated with Quality-Adjusted Life Years (QALYs) gains ranging from 1.35 to 2.72 across all countries. AID use resulted in significant relative risk reduction for long-term complications, such as proliferative diabetic retinopathy (51.3%), end-stage renal disease (39.5%), and severe vision loss (38.8%). Total cost savings ranged from USD-9340 in Australia to USD-28,798 in Canada. AID use was associated with an ICER of 14,590 in Australia, 25,798 in Canada, 32,459 in the UK, and 35,648 in USA per QALY gained (all values in USD). CONCLUSIONS: AID therapy was predicted to reduce mid- and long-term diabetes-related complications and improve quality of life while concomitantly reducing the economic burden on health care systems. AID was projected to be cost-effective versus MDI+CGM for pediatrics and adolescents with T1D in all analyzed countries. These findings highlight the need to accelerate the adoption of AID systems and to secure universal access and funding during this vulnerable period of life.