Smart connected insulin dose monitoring technologies versus standard of care: a Canadian cost-effectiveness analysis

Aim: There is growing interest in novel insulin management systems that improve glycemic control. This study aimed to evaluate the cost-effectiveness of smart connected insulin re-usable pens or caps for disposable insulin pens versus pens without connected capabilities in the management of adult patients with Type 1 diabetes (T1DM) from a Canadian societal perspective. Materials & methods: The IQVIA Core Diabetes Model was utilized to conduct the analyses. Applying data from a non-interventional study, the connected insulin device arm was assumed to result in greater reductions (-0.67%) in glycated hemoglobin from baseline and fewer non-severe hypoglycemic events (-32.87 events/patient annually). Macro-and micro-vascular risks were predicted using the Epidemiology of Diabetes Interventions and Complications study data. Direct and indirect costs and utilities were sourced from literature. Key model outcomes included life years and quality-adjusted life-years (QALYs). Both costs and effects were annually discounted at 1.5% over a 60-year time horizon. Uncertainty was explored in scenario and probabilistic sensitivity analyses (PSA). Results: The connected insulin pen device was associated with lower mean discounted total costs (CAD221,943 vs 266,199; -CAD44,256), improvement in mean life expectancy (25.78 vs 24.29; +1.49 years) and gains in QALYs (18.48 vs 16.74; +1.75 QALYs) over the patient's lifetime. Most scenario analyses confirmed the base case results. The PSA showed dominance in 99.5% of cases. Conclusion: For adults with T1DM in Canada, a connected insulin pen device is likely to be a cost-effective treatment option associated with greater clinical benefits and lower costs relative to a standard re-usable or disposable pen. Plain language summary: What is this article about?: People with Type 1 diabetes have challenges with keeping their blood glucose level under control, and risk episodes when these levels drop very low. Connected insulin pen devices are a type of digital technology available in Canada that can help address that. This article explores whether connected insulin pen devices are good value for money compared with standard re-usable or disposable pens. What were the results?: A cost-effectiveness analysis was done using a specially designed mathematical model that compared the benefits and costs of connected insulin pens with the standard treatment without connectivity technology. The modeling showed that use of connected insulin pens prolong life, improve its quality and save costs in the long run relative to standard re-usable or disposable pens. What do the results of the study mean?: The results suggest that in Canada, connected insulin pens could be a cost-effective option and should be considered for public reimbursement. Tweetable abstract: For adults with Type 1 diabetes mellitus in Canada, a connected insulin pen device is a cost-effective treatment option associated with greater clinical benefits and lower costs relative to a standard re-usable or disposable pen.