I would say once the technology is proven, it’s early days, the powers than be will realise the benefits of closed loop treatment, I’m 85-95% in my target range since using the pump, the health benefit of that kind of result will save them millions on treating diabetic related illnesses
I hope you're right.
However as future benefit e.g. morbidity avoided, survival extended is discounted due to preference for spending now, but the cost is incurred before as well as during the benefit period, this will put a higher demand on size of beneficial effect in addition to tge high on going costs of treatment with fancy kit.
As fag packet calc
Eg for a 26 yr old living til 71 assuming 10 yrs reduction in life on average on mdi
On multiple daily injections
Fixed Costs =£200
(Pen injector x2 £100 = £200
Glycaemia testor £0 )
Recurrent Costs £ pa
Disposable needle tips. pa £50
Insulin detemir £42/1500U =365*20U/day*42/1500. =£204pa
Insulin humalog £30/1500U. = £146pa
Blood test strips 6 / day +365*£15/50. =£657pa
Glucagon 4 pa +£11.52/mg = £46pa
2A+E visits pa. 2x250. =£500pa
1 o/n hospitalisatn pa. £1600pa
Consultancy Fees
Diabetic + opthamology 6 mnthly. £1000pa
estimate- i dont what these really cost
Total per patient
One off. £200
Recurrent: £4203pa
Lifetime £ = £0.189M
Quality Adjusted Yrs =45* 0.60 = 27
Survival = 45 yrs
----
pump.no sensor
Fixed Costs =£3000
(Pump £3000
Glycaemia testor £0 )
Recurrent Costs £ pa
Plastics
Canula £9.80 each, 3 days dur=9.8×365/3= £1192pa
Reservoirs £2.90 each, 3 says dur = 2.9x365/3= £353pa
Insulin humalog 40U/ day £16/1000U = £234pa
Blood test strips 6 / day +365*£15/50= £657pa
Glucagon 2 pa +£11.52/mg = £23pa
2 paramed visits pa. 2x125 = £250pa
est.
Consultancy Fees
Diabetic + opthamology 6 mnthly est. £1000pa
Total
One off. £3000
Recurrent: £3709pa
Lifetime £ = . £0.188M
Quality Adjusted Yrs =50* 0.66 = 33
Survival = . . . 50yrs
---
AI System
Fixed Costs =£5500
(Pump £5500 est )
Recurrent Costs £ pa
Plastics
Canula £9.80 each, 3 days dur=9.8×365/3= £1192pa
Reservoirs £2.90 each, 3 says dur = 2.9x365/3= £353pa
Insulin humalog 40U/ day £16/1000U = £234pa
Sensor £1200pa
Glucagon 0.25 pa +£11.52/mg = £2.88pa
0.25 pa paramed visits pa. 0.25x125. =£31.25pa
Consultancy Fees
Diabetic + opthamology 12 mnthly est. £500pa
Total
One off. Est £5500
Recurrent: £3513pa
Lifetime £ = £0.199M
Quality Adjusted Yrs =55* 0.8 = 44
Survival = 55yrs
Summary. Cost QALY. Survival( life years)
MDI. £0.189M. . 27. 45
Pump. £0.188M. 33. 50
AI. £0.199M. 44. 55
Table: summary
Incremental
Cost. QALY. Life yrs
P vs M £1000, 6, 5
£/QALY. £167/ QALY
£/LY. £200/LY
A vs M £10000, 17, 10
£/QALY. £588/QALY
£/LY. £1000/LY
A vs P. £11000, 11. 5
£/QALY. £1000/QALY
£/LY. £2200/LY
Outcome Difference Table
Key: M=MDI, P= pump no sensor, A= AI
Interpretation
The lower the extra (incremental).cost/ QALY and cost/ Life year, the more cost-effective the new treatment ( left hand as opposed to right hand letters in the Outcome Difference Table) .
The above uses estimates of QALY and survival effects more than costs and accordingly is at best indicative, rather than a fair estimate. Furthermore additional costs of t1d associated morbidity have not been added.
However as worse control would be expected with non-AI regulated management of t1d,
non-AI treatment would have higher costs eg from more patients requiring laser surgery, haemidialysis and the same patients suffering lower qol + survival than treatment by AI, which make a still stronger case for use of AI. Accordingly this would lessen the extra cost of AI vs ither treatments and increase the effect gains attribute to ai above other treatments. Combined, inclusion of diabetes related morbidities would further increase the likelihood of ai funding if tge assumptions in the nominal estimate were met. So i think there's hope, contingent on trial results and manufacturers' costs.
