Restricted accessResearch articleFirst published online 2025-10
Cost-Utility Analysis of the MiniMed ™ 780G Advanced Hybrid Closed-Loop System Versus Intermittently Scanned Continuous Glucose Monitoring with Multiple Daily Insulin Injections in People with Type 1 Diabetes in France
Advanced hybrid closed-loop (AHCL) automated insulin delivery systems such as the MiniMed™ 780G have been shown to result in substantial improvements in disease management in people living with type 1 diabetes. The aim of the analysis was to assess the cost utility of the MiniMed 780G system compared with intermittently scanned continuous glucose monitoring (is-CGM) and multiple daily insulin injections (MDI) in people living with type 1 diabetes in France, to estimate the incremental cost-utility ratio (ICUR) and inform decision-making.
Methods:
The analysis was performed using the CORE Diabetes Model (version 9.5) and clinical input data were sourced from a randomized controlled trial, with glycated hemoglobin reductions of 1.54% (16.8 mmol/mol) and 0.2% (2.18 mmol/mol) assumed for the MiniMed 780G arm and is-CGM + MDI arm, respectively. The analysis was conducted from a national payer perspective over a 40-year time horizon; future costs and clinical outcomes were discounted at 2.5% per annum.
Results:
In the base case analysis, use of the MiniMed 780G system was associated with a mean gain in quality-adjusted life expectancy of 2.26 quality-adjusted life years (QALYs) compared with is-CGM + MDI (16.33 QALYs vs. 14.07 QALYs), while mean direct lifetime costs were EUR 78,509 higher (EUR 215,037 vs. EUR 136,528), resulting in an ICUR of EUR 34,732 per QALY gained. Findings from sensitivity analyses showed that analyses were robust to changes in assumptions in most input parameters.
Conclusions:
In people with type 1 diabetes in France not achieving glycemic target levels at baseline, the use of the MiniMed 780G system was projected to lead to substantial improvements in quality-adjusted life expectancy compared with continued use of is-CGM + MDI, with an ICUR of EUR 34,732 per QALY gained.
GregoryGA, RobinsonTIG, LinklaterSE, et al.; International Diabetes Federation Diabetes Atlas Type 1 Diabetes in Adults Special Interest Group. Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: A modelling study. Lancet Diabetes Endocrinol, 2022; 10(10):741–760; doi: 10.1016/S2213-8587(22)00218-2
HoltRIG, DeVriesJH, Hess-FischlA, et al.The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia, 2021; 64(12):2609–2652; doi: 10.1007/s00125-021-05568-3
5.
SubramanianS, KhanF, HirschIB. New advances in type 1 diabetes. BMJ, 2024; 384:e075681; doi: 10.1136/bmj-2023-075681
6.
ChevreulK, Berg BrighamK, BouchéC. The burden and treatment of diabetes in France. Global Health, 2014; 10(1):6; doi: 10.1186/1744-8603-10-6
7.
MillerRG, OrchardTJ, CostacouT. 30-year cardiovascular disease in type 1 diabetes: Risk and risk factors differ by long-term patterns of glycemic control. Diabetes Care, 2022; 45(1):142–150; doi: 10.2337/dc21-1381
8.
LindM, PivodicA, SvenssonA-M, et al.HbA1c level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes: Swedish population based cohort study. Bmj, 2019; 366:l4894; doi: 10.1136/bmj.l4894
9.
RenardE, IkegamiH, Daher ViannaAG, et al.The SAGE study: Global observational analysis of glycaemic control, hypoglycaemia and diabetes management in T1DM. Diabetes Metab Res Rev, 2021; 37(7):e3430; doi: 10.1002/dmrr.3430
10.
DelagrangeM, Dalla-ValeF, SaletR, et al.Impact of deprivation on glycaemic control in youth with type 1 diabetes in the southwestern region of France. Pediatr Diabetes, 2021; 22(5):796–806; doi: 10.1111/pedi.13156
11.
Campas-LebecqueM-N, PocheluS, VautierV, et al.Do children and adolescents with type 1 diabetes suffer from a lack of resources in France? Results from a benchmark study in the New Aquitaine region. Arch Pediatr, 2021; 28(4):301–306; doi: 10.1016/j.arcped.2021.02.007
12.
LablancheS, DelagenièreJ, JalbertM, et al.12-month real-life efficacy of the MiniMed 780G advanced closed-loop system in patients living with type 1 diabetes: A French observational, retrospective, multicentric study. Diabetes Technol Ther, 2024; 26(6):426–432; doi: 10.1089/dia.2023.0414
13.
KesslerL, ThivoletC, PenfornisA, et al.Advanced hybrid closed loop algorithm use in type 1 diabetes: The French MiniMedTM Glycemic Control and Quality of Life study. Diab Ther, 2024; doi: 10.1007/s13300-024-01673-9
14.
ChoudharyP, KolassaR, KeuthageW, et al.; ADAPT study Group. Advanced hybrid closed loop therapy versus conventional treatment in adults with type 1 diabetes (ADAPT): A randomised controlled study. Lancet Diabetes Endocrinol, 2022; 10(10):720–731; doi: 10.1016/S2213-8587(22)00212-1
15.
JendleJ, BuompensiereMI, Ozdemir SaltikAZ, et al.A European cost-utility analysis of the MiniMedTM 780G advanced hybrid closed-loop system versus intermittently scanned continuous glucose monitoring with multiple daily insulin injections in people living with type 1 diabetes. Diabetes Technol Ther, 2023; 25(12):864–876; doi: 10.1089/dia.2023.0297
16.
PalmerAJ, RozeS, ValentineWJ, et al.The CORE Diabetes Model: Projecting long-term clinical outcomes, costs and cost-effectiveness of interventions in diabetes mellitus (types 1 and 2) to support clinical and reimbursement decision-making. Curr Med Res Opin, 2004; 20(Suppl 1):S5–S26; doi: 10.1185/030079904X1980
17.
PalmerAJ, RozeS, ValentineWJ, et al.Validation of the CORE Diabetes Model against epidemiological and clinical studies. Curr Med Res Opin, 2004; 20(Suppl 1):S27–S40; doi: 10.1185/030079904X2006
18.
McEwanP, FoosV, PalmerJL, et al.Validation of the IMS CORE Diabetes Model. Value Health, 2014; 17(6):714–724; doi: 10.1016/j.jval.2014.07.007
19.
NathanDM, DCCT/EDIC Research Group. The Diabetes Control and Complications Trial/Epidemiology of Diabetes interventions and Complications study at 30 years: Overview. Diabetes Care, 2014; 37(1):9–16; doi: 10.2337/dc13-2112
20.
RozeS, IsittJJ, Smith-PalmerJ, et al.Long-term cost-effectiveness the Dexcom G6 real-time continuous glucose monitoring system compared with self-monitoring of blood glucose in people with type 1 diabetes in France. Diabetes Ther, 2021; 12(1):235–246; doi: 10.1007/s13300-020-00959-y
SullivanPW, GhushchyanVH. EQ-5D scores for diabetes-related comorbidities. Value Health, 2016; 19(8):1002–1008; doi: 10.1016/j.jval.2016.05.018
23.
SolliO, StavemK, KristiansenIS. Health-related quality of life in diabetes: The associations of complications with EQ-5D scores. Health Qual Life Outcomes, 2010; 8(1):18; doi: 10.1186/1477-7525-8-18
24.
KnollGA, NicholG. Dialysis, kidney transplantation, or pancreas transplantation for patients with diabetes mellitus and renal failure: A decision analysis of treatment options. J Am Soc Nephrol, 2003; 14(2):500–515; doi: 10.1097/01.asn.0000046061.62136.d4
25.
HarrisS, MamdaniM, Galbo-JørgensenCB, et al.The effect of hypoglycemia on health-related quality of life: Canadian results from a multinational time trade-off survey. Can J Diabetes, 2014; 38(1):45–52; doi: 10.1016/j.jcjd.2013.09.001
26.
EvansM, KhuntiK, MamdaniM, et al.Health-related quality of life associated with daytime and nocturnal hypoglycaemic events: A time trade-off survey in five countries. Health Qual Life Outcomes, 2013; 11:90; doi: 10.1186/1477-7525-11-90
27.
Smith-PalmerJ, BaeJP, BoyeKS, et al.Evaluating health-related quality of life in type 1 diabetes: A systematic literature review of utilities for adults with type 1 diabetes. Clinicoecon Outcomes Res, 2016; 8:559–571; doi: 10.2147/CEOR.S114699
28.
CurrieCJ, MorganCL, PooleCD, et al.Multivariate models of health-related utility and the fear of hypoglycaemia in people with diabetes. Curr Med Res Opin, 2006; 22(8):1523–1534; doi: 10.1185/030079906X115757
29.
Haute Autorité de Santé. Choices in methods for health economic evaluation. Haute Autorité de Santé: Paris; 2020.
30.
BeaudetA, CleggJ, ThuressonP-O, et al.Review of utility values for economic modeling in type 2 diabetes. Value Health, 2014; 17(4):462–470; doi: 10.1016/j.jval.2014.03.003
31.
ChristensenMB, RanjanAG, RytterK, et al.Automated insulin delivery in adults with type 1 diabetes and suboptimal HbA1c during prior use of insulin pump and continuous glucose monitoring: A randomized controlled trial. J Diabetes Sci Technol, 2024:19322968241242399; doi: 10.1177/19322968241242399
32.
ChoudharyP, ArrietaA, van den HeuvelT, et al.Celebrating the data from 100,000 real-world users of the MiniMedTM 780G system in Europe, Middle East, and Africa collected over 3 years: From data to clinical evidence. Diabetes Technol Ther, 2024; 26(S3):32–37; doi: 10.1089/dia.2023.0433
33.
ArrietaA, BattelinoT, ScaramuzzaAE, et al.Comparison of MiniMed 780G system performance in users aged younger and older than 15 years: Evidence from 12 870 real-world users. Diabetes Obes Metab, 2022; 24(7):1370–1379; doi: 10.1111/dom.14714
34.
SmaniottoV, HellerS, O’NealD, et al.MiniMed 780G system performance in older users with type 1 diabetes: Real-world evidence and the case for stricter glycaemic targets. Diabetes Obes Metab, 2025; 27(4):2242–2250; doi: 10.1111/dom.16227
35.
PriggeR, McKnightJA, WildSH, et al.International comparison of glycaemic control in people with type 1 diabetes: An update and extension. Diabet Med, 2022; 39(5):e14766; doi: 10.1111/dme.14766
36.
MazzottaFA, Lucaccini PaoliL, RizziA, et al.Unmet needs in the treatment of type 1 diabetes: Why is it so difficult to achieve an improvement in metabolic control? Nutr Diabetes, 2024; 14(1):58; doi: 10.1038/s41387-024-00319-w
37.
LambadiariV, Ozdemir SaltikAZ, de PortuS, et al.Cost-effectiveness analysis of an advanced hybrid closed-loop insulin delivery system in people with type 1 diabetes in Greece. Diabetes Technol Ther, 2022; 24(5):316–323; doi: 10.1089/dia.2021.0443
38.
JendleJ, BuompensiereMI, HolmAL, et al.The cost-effectiveness of an advanced hybrid closed-loop system in people with type 1 diabetes: A health economic analysis in Sweden. Diabetes Ther, 2021; 12(11):2977–2991; doi: 10.1007/s13300-021-01157-0
39.
TéhardB, DetournayB, BorgetI, et al.Value of a QALY for France: a new approach to propose acceptable reference values. Value Health, 2020; 23(8):985–993; doi: 10.1016/j.jval.2020.04.001
40.
Cartier-BechuC, GherardiA, SivignonM, et al.Is there a threshold in France? First exhaustive review of published health-economic appraisals by the Haute Autorite De Sante (HAS), (French National Authority for Health). Value in Health, 2016; 19(7):A490; doi: 10.1016/j.jval.2016.09.830
41.
SambucC, SeguierC, TehardB, et al.Level of ICER of health economic assessment in France in 2023. In: Value in Health ISPOR: Barcelona, 2024; 27(12):S387; doi: 10.1016/j.jval.2024.10.1993
42.
PulkkinenM-A, VarimoTJ, HakonenET, et al.During an 18-month course of automated insulin delivery treatment, children aged 2 to 6 years achieve and maintain a higher time in tight range. Diabetes Obes Metab, 2024; 26(6):2431–2438; doi: 10.1111/dom.15562
43.
van DongenJM, Jornada BenÂ, FinchAP, et al.Assessing the impact of EQ-5D country-specific value sets on cost-utility outcomes. Med Care, 2021; 59(1):82–90; doi: 10.1097/MLR.0000000000001417
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