Economics of Improved Time in Range in Type 1 Diabetes Management in Italy, Spain, Greece, and Israel
Author(s)
Asli Zeynep Ozdemir Saltik, MS, Maria Ida Buompensiere, MS, Simona de Portu, Pharm D, MS, MBA, Jessica Yu, MS.
Health Economics, Reimbursement and Government Affairs, Diabetes, International, Medtronic International Trading Sarl, Tolochenaz, Switzerland.
Health Economics, Reimbursement and Government Affairs, Diabetes, International, Medtronic International Trading Sarl, Tolochenaz, Switzerland.
OBJECTIVES: Time in range (TIR) is a key target in managing people with type 1 diabetes (PwT1D). Time spent in a glucose range of 70-180 mg/dL (3.9-10.0 mmol/L) is recommended to be >70%, which has been linked to reduced complication incidence. While frequently used in evaluating automated insulin delivery (AID) systems, TIR has rarely been applied in health economic assessments. We examined the impact of a 10%-point increase in TIR on clinical and economic outcomes for PwT1D in Italy, Greece, Spain and Israel.
METHODS: Four baseline TIR levels (50%, 60%, 70%, 80%) and the investigated TIR increase were mapped to glycated hemoglobin (HbA1c) using two published statistical approaches[1],[2]. HbA1c estimates informed the IQVIA CORE Diabetes Model (version 10), projecting complication incidence, quality-adjusted life expectancy (QALE) and costs over 20 years, from a public healthcare system perspective. Cohort baseline data, complication costs, and utilities were sourced from published literature for each country. [1] Beck RW, et al. J Diabetes Sci Technol. 2019;13(4):614-626. [2] Vigersky RA, McMahon C. Diabetes Technol Ther. 2019;21(2):81-85.
RESULTS: A 10%-point increase in TIR projected reductions in the cumulative complications’ incidence, by 29-41%, 17-25%, 10-17%, and 10-16% for ophthalmic, renal, neuropathic and cardiovascular complications respectively, when averaged across baseline TIR levels and sub-complications. Fewer complications translated into QALE-gains of 0.130-0.371 years. Total projected reductions in complication costs ranged between 8.8-13.6%, corresponding to an average reduction of %11.4 across countries and baseline TIR levels. For both QALE-gains and cost-savings, higher gains were observed for lower baseline TIR levels.
CONCLUSIONS: A 10%-point increase in TIR is projected to reduce the cumulative incidence of diabetic complications in PwT1D, leading to lower costs in treating these complications. These findings highlight the potential long-term clinical and economic value of achieving higher TIR in T1D management, which can be obtained using AID system.
METHODS: Four baseline TIR levels (50%, 60%, 70%, 80%) and the investigated TIR increase were mapped to glycated hemoglobin (HbA1c) using two published statistical approaches[1],[2]. HbA1c estimates informed the IQVIA CORE Diabetes Model (version 10), projecting complication incidence, quality-adjusted life expectancy (QALE) and costs over 20 years, from a public healthcare system perspective. Cohort baseline data, complication costs, and utilities were sourced from published literature for each country. [1] Beck RW, et al. J Diabetes Sci Technol. 2019;13(4):614-626. [2] Vigersky RA, McMahon C. Diabetes Technol Ther. 2019;21(2):81-85.
RESULTS: A 10%-point increase in TIR projected reductions in the cumulative complications’ incidence, by 29-41%, 17-25%, 10-17%, and 10-16% for ophthalmic, renal, neuropathic and cardiovascular complications respectively, when averaged across baseline TIR levels and sub-complications. Fewer complications translated into QALE-gains of 0.130-0.371 years. Total projected reductions in complication costs ranged between 8.8-13.6%, corresponding to an average reduction of %11.4 across countries and baseline TIR levels. For both QALE-gains and cost-savings, higher gains were observed for lower baseline TIR levels.
CONCLUSIONS: A 10%-point increase in TIR is projected to reduce the cumulative incidence of diabetic complications in PwT1D, leading to lower costs in treating these complications. These findings highlight the potential long-term clinical and economic value of achieving higher TIR in T1D management, which can be obtained using AID system.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE405
Topic
Clinical Outcomes, Economic Evaluation, Medical Technologies
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)