OBJECTIVES: Sensor-augmented pump therapy (SAP) combines continuous glucose monitoring with continuous subcutaneous insulin infusion (CSII). SAP is costlier than CSII but provides additional clinical benefits over CSII alone. This study aims to determine whether SAP therapy with PLGM algorithm is cost-effective versus CSII in people living with T1D in Bulgaria.

METHODS: A cost effectiveness analysis was performed using the validated IQVIA CORE Diabetes Model. Clinical and economic inputs were derived from published literature and expert opinion. Separate analyses were performed for hypoglycemic (baseline hypoglycemic event [HE] rate 90/100-patient-years) with baseline HbA1c 7.5% and hyperglycemic (baseline HE rate 10/100-patient-years) with baseline HbA1c 9% cohorts, using a patient-lifetime time horizon. Analyses considered the payer’s perspective. Future costs and clinical outcomes were discounted at 3.5% per annum.

RESULTS: The between arm difference in HbA1c reduction was assumed to be -0.56% for hypoglycemic and -0.75% for hyperglycemic cohorts, favouring SAP, based on the formulae derived from a meta-analysis (Pickup JC. et al. BMJ. 2011;343:d3805). An 83% reduction of HE rates with SAP vs CSII was assumed for both cohorts (Choudhary P. et al. Diabetes Technol Ther. 2016 May;18(5):288-91).

• SAP was projected to lead to an incremental gain of 2.14 quality-adjusted life years (QALYs) in the hypoglycemic cohort and of 1.13 QALYs in the hyperglycemic cohort.
• SAP usage increased the mean years of life free from complications, leading up to 3- and 5-years delay in complications onset versus CSII for hypoglycemic and hyperglycemic cohorts, respectively.
• Higher mean lifetime direct costs for SAP versus CSII resulted in projected incremental cost-effectiveness ratios of BGN40.206/QALY-gained for hypoglycemic and BGN74.403/QALY-gained for hyperglycemic cohorts.
• Extensive deterministic and probabilistic sensitivity analyses confirmed the robustness of results.

CONCLUSIONS: In Bulgaria, SAP therapy likely represents good value for money versus CSII in T1D management, particularly for the patients experiencing frequent and/or problematic hypoglycemic events.