LAUSR

A recent publication in Diabetes Therapy from Jendle and colleagues [1] reports on the costeffectiveness of the MiniMed 780G advanced hybrid closed-loop (AHCL) system (Medtronic, Northridge, CA) in people with type 1 diabetes (T1DM) in Sweden, by comparison with the intermittently scanned FreeStyle Libre flash glucose monitoring system (Abbott, Witney, UK) when used in conjunction with multiple daily insulin injections (MDI) or with continuous subcutaneous insulin infusion (CSII). The authors conclude that the MiniMed 780G AHCL is cost-effective compared to the FreeStyle Libre system plus MDI or CSII for treating people with T1DM. We must argue that this conclusion depends on modelling assumptions that have the potential to introduce bias into the assignment of value to health-state utilities as part of cost-effectiveness models [2]. Firstly, the authors claim reduced incidence and delayed time to onset of diabetes-related complications for the AHCL system versus the FreeStyle Libre system plus MDI or CSII, based on the treatment effects of each system, documented in only two selected studies [3, 4]. In the first, a randomized clinical trial (RCT) [3], the authors assert a reduction in HbA1c of 0.5% (5.5 mmol/mol) for the MiniMed 780G system, when used in the 4-week intervention phase. However, this is not reported in the outcomes data or supplementary materials, which focus on increased time in range (TIR) 3.9–10 mmol/L and reduced average glucose. Although these are reported to correlate to a glucose management indicator (GMI) of 6.8% in the intervention arm, this should not necessarily be assumed to be equivalent to change in long-term laboratory HbA1c, which can differ significantly [5]. They then cite the 6–12-month outcomes from the FUTURE study [4] as evidence of no change in HbA1c from baseline using the FreeStyle Libre system in T1DM. By making the extrapolation from improved sensor-glucose metrics to a change in HbA1c from a 4-week RCT intervention [3] and comparing it with observed HbA1c outcomes from a single 12-month real-world study [4] is unrealistic in a cost-effectiveness calculation. There are no head-to-head studies that assess the two F. Levrat-Guillen (&) Abbott Laboratories Ltd, Abbott House, Vanwall Business Park, Maidenhead, Berkshire SL6 4XE, UK e-mail: [email protected]