Inter-Regional Center for Automated Insulin in Diabetes (CIRDIA) and Hospital-Based Approaches to Closed-Loop Therapy in Type 1 Diabetes: Cost-Effectiveness Analysis

TL;DR

A study in France found that outpatient care for automated insulin delivery in diabetes is as effective as hospital care but costs significantly less.

Contribution

The study demonstrates that outpatient centers like CIRDIA are a cost-effective alternative to hospital-based closed-loop insulin therapy for type 1 diabetes.

Findings

Outpatient care at CIRDIA achieved similar efficacy and safety outcomes as hospital-based care after 12 months.

CIRDIA was associated with significantly lower management costs per patient compared to hospital-based care.

Probabilistic sensitivity analysis showed CIRDIA was less costly in 86% of simulations.

Abstract

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

This study (cost-effectiveness analysis) compares 2 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.

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 (hospital center [HC] group). The cost analyses were based on patient records and public databases: the French Medical Information Systems Program and the French General Nomenclature of Professional Acts. Closed-loop efficacy was assessed using a time in range (TIR) of 70 to 180 mg/dL, and closed-loop safety was assessed using the glycemia risk index (GRI), a single indicator that represents the risk of hypoglycemia or hyperglycemia and ranges from 0 (minimal risk) to 100 (maximal risk).

A total of 201 patients were included: 128 in the CIRDIA group and 73 in the HC group. The mean (SD) age was 43 (14) years and 46 (15) years, respectively. Mean (SD) baseline TIR was 52.9% (16%) in the CIRDIA group versus 65.9% (15.1%) in the HC group (P<.001), whereas mean (SD) 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 at 30.1 (14.1) versus 30.3 (13), respectively. There were no significant between-group differences (P=.60 for TIR; P=.91 for GRI). However, the CIRDIA was associated with significantly lower management costs with a mean cost of €8373.12 (SD €427.30; €1=US $1.10 at the time of the study) per patient in the CIRDIA group versus €8814.32 (SD €192) per patient in the HC group (P<.001). The estimated saving was €626 per percentage point of increase in TIR and €2011 per point of reduction in GRI, indicating that the HC closed-loop initiation was dominated by the CIRDIA. The CIRDIA was less costly than HC in 8600 (86%) out of 10,000 simulations in a probabilistic sensitivity analysis.

These findings suggest the potential of the 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.

Figures