SIMULATING TREATMENT ESCALATION IN TYPE 2 DIABETES DISEASE STATE MODELING: AN APPLICATION TO COST-EFFECTIVENESS ANALYSIS OF TUBELESS AUTOMATED INSULIN DELIVERY
Author(s)
Joshua Weinstein, PhD1, Dan Carlow, MPH1, Colin Hopley, MBA, MPH2, Kevin Xue, PhD3, Erin Wong, PhD3, Kirk Szafranski, MSc3.
1Insulet Corporation, Acton, MA, USA, 2Insulet Corporation, London, United Kingdom, 3EVERSANA, Toronto, ON, Canada.
1Insulet Corporation, Acton, MA, USA, 2Insulet Corporation, London, United Kingdom, 3EVERSANA, Toronto, ON, Canada.
OBJECTIVES: Type 2 diabetes (T2D) is highly prevalent and has seen notable therapeutic advances, including several medications with different mechanisms of action and automated insulin delivery (AID). The 2026 American Diabetes Association (ADA) guidelines and the 2022 joint consensus with the European Association for the Study of Diabetes emphasize timely treatment modification when glycemic goals are not met. We evaluated the influence of sequential treatment escalation on cost-effectiveness, comparing tubeless disposable AID plus background therapy versus non-AID standard of care (SoC). The SoC arm reflected non-AID intensive diabetes management, comprising basal insulin, basal-bolus insulin, and continuous subcutaneous insulin infusion (CSII) at baseline.
METHODS: Cost-effectiveness analyses were conducted using the Simulation of Costs, Outcomes, and Treatment Dynamics in Type 2 Diabetes Mellitus (SCOTT2) model from a US payer perspective. A treatment escalation module simulated progression through non-insulin regimens used independently or as background to insulin. Non-insulin therapies included oral antidiabetic agents, sodium-glucose cotransporter-2 inhibitors, and GLP-1 RA medications. Patients could then escalate to basal insulin, multiple daily injections, or continuous subcutaneous insulin infusion. All model settings were identical except for escalation. The model was run with escalation off and with escalation triggered at HbA1c thresholds of 9.0%, 8.5%, 8.0%, 7.5%, and 7.0%.
RESULTS: Compared to static treatment in the comparator arm, treatment escalation produced notably lower incremental cost utility ratios (ICURs), driven more by reduced incremental costs rather than growth of incremental QALYs. Static treatment produced an ICUR of $66,428/QALY, versus $9,014 to $12,565 per QALY with escalation incorporated.
CONCLUSIONS: Simulating treatment escalation and discontinuation to reflect guideline-concordant real-world care practice can notably influence cost-effectiveness endpoints in T2D. Researchers should carefully consider treatment modification logic across the broad spectrum of treatments for T2D in disease state modeling.
METHODS: Cost-effectiveness analyses were conducted using the Simulation of Costs, Outcomes, and Treatment Dynamics in Type 2 Diabetes Mellitus (SCOTT2) model from a US payer perspective. A treatment escalation module simulated progression through non-insulin regimens used independently or as background to insulin. Non-insulin therapies included oral antidiabetic agents, sodium-glucose cotransporter-2 inhibitors, and GLP-1 RA medications. Patients could then escalate to basal insulin, multiple daily injections, or continuous subcutaneous insulin infusion. All model settings were identical except for escalation. The model was run with escalation off and with escalation triggered at HbA1c thresholds of 9.0%, 8.5%, 8.0%, 7.5%, and 7.0%.
RESULTS: Compared to static treatment in the comparator arm, treatment escalation produced notably lower incremental cost utility ratios (ICURs), driven more by reduced incremental costs rather than growth of incremental QALYs. Static treatment produced an ICUR of $66,428/QALY, versus $9,014 to $12,565 per QALY with escalation incorporated.
CONCLUSIONS: Simulating treatment escalation and discontinuation to reflect guideline-concordant real-world care practice can notably influence cost-effectiveness endpoints in T2D. Researchers should carefully consider treatment modification logic across the broad spectrum of treatments for T2D in disease state modeling.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE19
Topic
Economic Evaluation, Medical Technologies, Study Approaches
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)