open access publication

Article, 2024

Smart connected insulin dose monitoring technologies versus standard of care: a Canadian cost–effectiveness analysis

Journal of Comparative Effectiveness Research, ISSN 2042-6305, 2042-6313, Volume 13, 3, Page e230124, 10.57264/cer-2023-0124

Contributors

Chan, Katalina 0000-0003-0638-8352 (Corresponding author) [1] Hansen, Kåre [2] Muratov, Sergey [3] [4] Khoudigian, Shoghag [4] Lamotte, Mark [5]

Affiliations

  1. [1] Novo Nordisk (Canada)
    2. [NORA names: Canada; America, North; OECD];
  2. [2] Novo Nordisk (Denmark)
    3. [NORA names: Novo Nordisk; Private Research; Denmark; Europe, EU; Nordic; OECD];
  3. [3] McMaster University
    4. [NORA names: Canada; America, North; OECD];
  4. [4] IQVIA, Real World Solutions (RWS), Mississauga, Ontario, L4W 5N9, Canada
    5. [NORA names: Canada; America, North; OECD];
  5. [5] Th(is)2Modeling bv, Hogeweg, 91730, Asse, Belgium
    6. [NORA names: Belgium; Europe, EU; OECD]

Abstract

Aim: There is growing interest in novel insulin management systems that improve glycemic control. This study aimed to evaluate the cost-effectiveness of smart connected insulin re-usable pens or caps for disposable insulin pens versus pens without connected capabilities in the management of adult patients with Type 1 diabetes (T1DM) from a Canadian societal perspective. Materials & methods: The IQVIA Core Diabetes Model was utilized to conduct the analyses. Applying data from a non-interventional study, the connected insulin device arm was assumed to result in greater reductions (-0.67%) in glycated hemoglobin from baseline and fewer non-severe hypoglycemic events (-32.87 events/patient annually). Macro- and micro-vascular risks were predicted using the Epidemiology of Diabetes Interventions and Complications study data. Direct and indirect costs and utilities were sourced from literature. Key model outcomes included life years and quality-adjusted life-years (QALYs). Both costs and effects were annually discounted at 1.5% over a 60-year time horizon. Uncertainty was explored in scenario and probabilistic sensitivity analyses (PSA). Results: The connected insulin pen device was associated with lower mean discounted total costs (CAD221,943 vs 266,199; -CAD44,256), improvement in mean life expectancy (25.78 vs 24.29; +1.49 years) and gains in QALYs (18.48 vs 16.74; +1.75 QALYs) over the patient's lifetime. Most scenario analyses confirmed the base case results. The PSA showed dominance in 99.5% of cases. Conclusion: For adults with T1DM in Canada, a connected insulin pen device is likely to be a cost-effective treatment option associated with greater clinical benefits and lower costs relative to a standard re-usable or disposable pen.

Keywords

CORE Diabetes Model, Canada, Canadian cost-effectiveness analysis, Canadian societal perspective, Diabetes Interventions, Epidemiology of Diabetes Interventions, IQVIA, IQVIA CORE Diabetes Model, T1DM, adult patients, adults, analysis, arm, associated with greater clinical benefit, associated with lower mean, base, base case, baseline, benefits, cap, capability, care, cases, clinical benefit, complications, control, cost, cost-effective, cost-effective treatment option, cost-effectiveness analysis, data, device arm, devices, diabetic model, disposable insulin pens, disposable pen, dominance, effect, epidemiology, events, expectations, gain, glycated hemoglobin, glycemic control, hemoglobin, hypoglycemic events, improve glycemic control, improvement, indirect costs, insulin, insulin pen devices, insulin pens, intervention, life, life expectancy, life years, lifetime, literature, low cost, lowest mean, macro-, management, management of adult patients, management system, mean, mean life expectancy, model, monitoring, monitoring technology, non-interventional study, non-severe hypoglycemic events, options, outcomes, patient's lifetime, patients, pen, pen device, perspective, probabilistic sensitivity analyses, quality-adjusted life years, re-use, reduction, risk, scenario analysis, scenarios, sensitivity analysis, societal perspective, standard of care, standards, study, study data, system, technology, treatment options, type, type 1 diabetes, uncertainty, utilization, years

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