JMIR Publications

ABSTRACT

Background:

Closed-loop insulin delivery is the new standard of care for patients with type 1 diabetes (T1D). However, in France, its implementation remains predominantely hospital based. Expanding access to this treatment through alternative care models looks essential.

Objective:

This study (cost-effectiveness analysis) compares two care models for people with T1D implementing a closed-loop system in France : outpatient care in the Inter-Regional Center for Automated Insulin in Diabetes (CIRDIA) and inpatient care.

Methods:

We conducted a cost-effectiveness analysis using retrospective observational data from individuals with T1D aged 16 years and older from the implementation of the closed-loop to a 12-month follow-up either in the CIRDIA (CIRDIA group) or in a hospital center setting (HC group). The cost analyses were based on patient records and public databases: the French Medical Information Systems Program (PMSI) and the French General Nomenclature of Professional Acts (NGAP). Closed-loop efficacy was assessed using the time in range 70-180 mg/dL (TIR) and closed-loop safety was assessed using the glycemia risk index (GRI), a single indicator that represents the risk of hypoglycemia/hyperglycemia and ranges from 0 (minimal risk) to 100 (maximal risk).

Results:

A total of N=201 patients were included: N=128 in the CIRDIA group and N=73 in the HC group. The mean (SD) age was respectively 43 (14) years and 46 (15) years. Baseline TIR was 52.9% (16) in the CIRDIA group versus 65.9% (15.1) in the HC group (P<.001) whereas baseline GRI was 56.4 (21) in the CIRDIA group versus 37.8 (19.8) in the HC group (P<.001). After 12 months, both groups achieved similar efficacy and safety outcomes with a mean (SD) TIR at 72.7% (11.6) in the CIRDIA group versus 71.9% (10.5) in the HC group, and a mean GRI respectively at 30.1 (14.1) versus 30.3 (13). There were no significant between-group differences (P=.6 for TIR; P=.91 for GRI). However, CIRDIA was associated with significantly lower management costs with a mean (SD) cost of €8373.12 (427.3) per patient in the CIRDIA group versus €8814.32 (192) per patient in the HC group (P<0.001). The estimated saving was €626 per percentage point of increase in TIR and €2011 per point of reduction in GRI, indicating that HC closed-loop initiation was dominated by CIRDIA. The CIRDIA was less costly than HC in 86% of the cases.

Conclusions:

These findings suggest the potential of CIRDIA to represent a viable alternative organizational model for closed-loop initiation in France, achieving comparable effectiveness at lower cost in our population. Further research with longer follow-up is warranted. From a policy perspective, the resources saved could be at least partly reallocated to support out-of-hospital closed-loop initiation centers. Clinical Trial: Not Applicable