Cost-Effectiveness of Automated Insulin Delivery Systems in Paediatrics, T1D and T2D Adults Across Four Nordic Countries

AIMS: This study evaluated long-term cost-effectiveness of automated insulin delivery (AID) systems versus multiple daily injections (MDI) + CGM in children with type 1 diabetes (T1D), adults with T1D and insulin-treated individuals with type 2 diabetes (T2D) across Denmark, Finland, Norway and Sweden.

MATERIALS AND METHODS: Clinical outcomes and economic footprints were analysed for horizons up to 50 years from a healthcare system perspective using the IQVIA Core Diabetes Model. Five patient profiles were modelled: T1D paediatrics (T1D-Paed), T1D adults with high baseline HbA1c (T1D-Adult), real-world evidence in T1D adults with lower baseline HbA1c (T1D-AdultRWE), T2D adults (T2D-Adult) and older T2D adults (T2D-Elder). Costs were inflated to July 2024, with 3% annual discounting. Sensitivity analyses explored scenarios varying time horizons and HbA1c effect sizes and inclusion of hypoglycaemia rates.

RESULTS: AID systems were estimated to lead to a reduction in diabetes-related complications in all groups, most notably in the T1D-Adult group (318 vs. 542 complications per 100 individuals). Improvements translated into lifetime cost savings (€1435 to €26 259), increased life expectancy (LE) and more quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios (ICERs) remained below willingness-to-pay thresholds in all countries (from €14 695/QALY for T1D-Adult in Finland to €56 711/QALY for T1D-AdultRWE in Denmark), confirming AID is cost-effective across all groups in the Nordic region.

CONCLUSIONS: AID therapy consistently projected reduced diabetes-related complications while remaining cost-effective across a broad spectrum of diabetes patient profiles in the Nordic region. These findings strengthen the case towards widespread integration of AID technology into national diabetes care frameworks.