This paper is about the cost-effectiveness of hybrid closed-loop artificial pancreas systems in patients with type 1 diabetes.
Advances in diabetes technology over the past decade have culminated in the commercialization of hybrid closed-loop (HCL) artificial pancreas systems, alleviating the onus of self-management in type 1 diabetes (T1D). Clinical effectiveness benefits over conventional systems are well-documented. However, no systematic review has been performed on the cost-effectiveness of HCL systems, even if health economic assessments are integral to guide policy decisions.
To perform a systematic review, critical analysis, and narrative synthesis of available economic evaluations of HCL systems for T1D patients and upcoming cost-effectiveness studies within the research pipeline.
A systematic search was conducted following the PRISMA 2020 guidelines in MEDLINE, Embase, and CENTRAL via Ovid in October 2021. A review of trial registries and grey literature, as well as reference list and forward citation search, complemented the search. Predefined eligibility criteria were used. Retrieved studies underwent CHEERS-based quality assessment. Data were subsequently extracted via a standardized data extraction form. Results were presented through narrative synthesis, dominance ranking framework, and display of standardized ICERs (in 2021 GBP) in a cost-effectiveness plane.
Of the 213 records retrieved via systematic review and 331 identified through other search methods, 8 were included in the review and 11 in the research pipeline. Overall, included studies demonstrated good quality. Standardized ICERs ranged from 5,688 to 30,293 GBP per QALY gained. Limitations of included evidence were discussed in detail and contain lack of long-term effectiveness data and inter-system comparisons, as well as possible conflicts of interest.
Overall results suggest cost-effectiveness for HCL systems compared to current treatment standards such as CSII, CGM, and SAP. Additional high-quality, large scale, and long-term economic research is required to assess health economic outcomes for HCL technology in clinical practice. This thesis provides fundamental starting points in the research pipeline as a basis of further research.
Table of Contents
1 Introduction
1.1 Background and Critique of Literature
1.2 Research Gap and Rationale for Study
1.3 Research Questions, Aims, and Objectives of Study
2 Methodology
2.1 Systematic Literature Search
2.2 Grey Literature Search
2.3 Eligibility Criteria
2.4 Selection Process
2.5 Assessment of Methodological Quality
2.6 Data Extraction
2.7 Data Synthesis
2.8 Risk of Bias Assessment
3 Results
3.1 Study Selection
3.2 Characteristics of Included Studies
3.3 Critical Appraisal of Included Studies
3.4 Findings of the Review
3.5 Research Pipeline for Cost-Effectiveness of HCL
4 Discussion
4.1 Interpretation of Results in the Context of Existing Evidence
4.2 Limitations of the Evidence Included in the Review
4.3 Strengths and Limitations of the Review Process
4.4 Implications of Results for Practice and Policy
4.5 Implications of Results for the Future Research Agenda
4.6 Conclusion
5 Final Notes
5.2 Registration and Protocol
5.3 Support and Competing Interests
5.4 Availability of Material
Objectives and Themes
The primary objective of this dissertation is to conduct a systematic review and critical analysis of existing economic evaluations concerning hybrid closed-loop (HCL) artificial pancreas systems for patients with type 1 diabetes, aimed at assessing their cost-effectiveness to inform clinical policy and future research.
- Critical synthesis of health economic evidence for HCL artificial pancreas systems.
- Evaluation of methodological quality in current cost-effectiveness studies.
- Comparative analysis of incremental cost-effectiveness ratios (ICERs).
- Identification of the research pipeline for upcoming economic evaluations.
- Determination of cost-effectiveness as a basis for reimbursement and clinical adoption.
Auszug aus dem Buch
1.1 Background and Critique of Literature
Diabetes mellitus affects 463 million people worldwide, while the global prevalence is estimated to reach 700 million by 2045 (Saeedi et al., 2019). With 10% of total global health expenditure spent on diabetes, the ‘pandemic disease’ exerts a considerable economic burden on health care systems worldwide (IDF, 2019, Toniolo et al., 2019).
Type 1 diabetes (T1D) patients can only achieve normoglycaemia through external insulin substitution and adherence to a strict insulin regimen (Kovatchev, 2018, ADA, 2020). Rigorous monitoring of blood glucose levels and insulin dosing is crucial to maintain glycaemic control and avoid acute hypoglycaemia, medical complications, and long-term comorbidities (Evans Kreider et al., 2017). Besides the lifelong burden of a chronic degressive disease patients also face time-consuming manual monitoring obligations (Hameed and Kleinberg, 2020).
By offering convenience through automation, subcutaneous continuous glucose monitoring (CGM) devices have largely replaced the practice of manual self-monitoring of blood glucose (SMBG) via finger prick testing (Benjamin, 2002, Welsh and Thomas, 2019). On the other hand, continuous subcutaneous insulin infusion (CSII) pumps – which provide a steady flow of basal insulin and partly additional meal-related bolus insulin (Pickup, 2002) – have not yet superseded manual insulin dosing practice via multiple daily injections (MDI) (ADA, 2020). Thus, potential benefits from using advanced CGM devices stay limited to human capacities. On the other hand, increased adoption of CSIIs or automated insulin delivery (AID) systems would allow for more effective diabetes management, leading to fewer complications, substantial time savings, and improved quality of life (Kowalski, 2009, Bernand, 2017, Boughton and Hovorka, 2021).
Summary of Chapters
1 Introduction: Provides the global context of diabetes mellitus, the clinical challenges of T1D management, and establishes the rationale for evaluating the cost-effectiveness of HCL systems.
2 Methodology: Outlines the systematic review process, including search strategies in medical databases, eligibility criteria, and the application of JBI and CHEERS guidelines for quality assessment.
3 Results: Presents the findings from the systematic search, including study selection, characteristics, critical appraisals, and a synthesized overview of cost-effectiveness data and the future research pipeline.
4 Discussion: Interprets the review's findings, highlights strengths and limitations of the available evidence, and provides implications for clinical practice, health policy, and future research agendas.
5 Final Notes: Confirms the administrative aspects of the study, including protocol registration, non-funded status, and the location of supporting appendices.
Keywords
Systematic review, diabetes technology, closed-loop systems, economic evaluation, cost-effectiveness, quality assessment, type 1 diabetes, health economics, artificial pancreas, clinical outcomes, reimbursement, insulin delivery, medical device, cost-effectiveness plane, ICER.
Frequently Asked Questions
What is the core focus of this dissertation?
This work examines the cost-effectiveness of hybrid closed-loop (HCL) artificial pancreas systems compared to standard diabetes treatment options for patients with type 1 diabetes.
What are the central research themes?
The themes include the clinical and economic impact of automated insulin delivery, the standardization of health economic reporting, and the appraisal of existing trial evidence.
What is the primary research objective?
The goal is to determine if HCL systems serve as a cost-effective alternative by aggregating and evaluating evidence from available health economic literature.
Which scientific methodology is utilized?
The author employs a systematic review methodology, adhering to PRISMA 2020 and JBI guidelines, complemented by a narrative synthesis of economic outcomes.
What topics are covered in the main body?
The main body covers the background of diabetes technology, systematic search strategies, methodological quality appraisal of included studies, detailed findings on ICERs, and an analysis of the future research pipeline.
How is this research characterized by keywords?
The work is defined by terms such as systematic review, cost-effectiveness, HCL, type 1 diabetes, and economic evaluation.
How were cost-effectiveness ratios standardized across different currencies?
The author applied OECD purchasing power parities and adjusted for inflation using UK consumer price indices to convert results into 2021 GBP per QALY.
What does the author conclude regarding the cost-effectiveness of HCL systems?
The research indicates that HCL systems generally demonstrate cost-effectiveness in clinical practice, though limited long-term data and methodological heterogeneity require further high-quality research.
- Arbeit zitieren
- Kim Vanessa Enders (Autor:in), 2022, Cost-effectiveness of hybrid closed-loop artificial pancreas systems in patients with type 1 diabetes, München, GRIN Verlag, https://www.grin.com/document/1191832
