Cost-Effectiveness of the MiniMed 780G System for Type 1 Diabetes

ABSTRACT

Objectives: Advances in diabetes technology have led to improved glycemic control. However, no study has evaluated the economic impact of advanced hybrid closed-loop (AHCL) technology in the US compared with older and less expensive treatments. We assessed the cost-effectiveness of the MiniMed 780G system (MM780G) with AHCL technology vs multiple daily injections of insulin (MDI) with intermittently scanned continuous glucose monitoring (isCGM) among patients with type 1 diabetes (T1D) in the US.

Study Design: A 6-month randomized controlled trial compared MM780G against MDI with isCGM among patients with T1D. Outcomes included changes in hemoglobin A_1c and quality of life.

Methods: We used the IQVIA Core Diabetes Model to simulate direct costs and quality of life separately over a 4-year horizon and a lifetime horizon. Treatment effects were sourced from the randomized controlled trial, and utilities and disutilities for diabetes-related complications came from the literature. We generated incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves for the base case and 5 one-way sensitivity analyses.

Results: At a willingness-to-pay threshold of $100,000, MM780G is cost-effective in the base case, with an ICER of $68,402 per quality-adjusted life-year over a 4-year horizon and $38,842 per quality-adjusted life-year over a lifetime horizon. Sensitivity analyses varying the rates of short-term complications, pricing, and assumptions about treatment-related utilities show cost-effectiveness at a threshold of $100,000 in all but 1 case.

Conclusions: MM780G is likely to be cost-effective vs MDI with isCGM in patients with T1D in the US at a willingness-to-pay threshold of $100,000.

Am J Manag Care. 2025;31(4):In Press

Takeaway Points

The MiniMed 780G insulin pump system is a cost-effective treatment option in the US for type 1 diabetes vs multiple daily injections with intermittently scanned continuous glucose monitoring.

• Although the MiniMed 780G system has a greater cost than the comparator, it is generally cost-effective over 4-year and lifetime horizons due to improved quality of life and reduced rates of complications. These data can inform coverage decisions by payers and prescribing decisions by providers.
• The findings are consistent with previous studies in Europe and Singapore but are the first to demonstrate MiniMed 780G system cost-effectiveness in the US.

Type 1 diabetes (T1D) affects approximately 1.8 million individuals in the US¹ and is caused by an autoimmune process that destroys the β cells of the pancreas, resulting in an inability to produce insulin. T1D is associated with an increased risk of long-term complications (eg, cardiovascular disease, nephropathy, retinopathy), particularly among those with less than optimal glycemic control. Short-term complications, including severe hypoglycemia and diabetic ketoacidosis, affect quality of life and can be fatal.

In addition to its adverse physical effects, T1D takes a significant toll mentally and emotionally. Patients and caregivers face a substantial emotional burden in managing T1D,^2,3 and rates of depression among people with T1D (PWT1D) are significantly higher than among the general population.⁴ Although patient and caregiver burden and T1D’s impact on quality of life may be alleviated by switching to alternative therapies,^5-7 these cost more than standard treatments.

T1D also presents a substantial economic burden to the US health care system and to patients through the cost of treatment and the cost of treating complications. A simulation study estimated that over a lifetime, the difference in direct and indirect costs between people with and without T1D in the US was $813 billion.⁸ Of the estimated medical expenditures, 31% were paid out of pocket by the patient, resulting in excess out-of-pocket direct costs of $75,000 per patient with T1D over a lifetime.

The standard treatment for T1D in the US has been intensive insulin therapy delivered via multiple daily injections of insulin (MDI) or continuous subcutaneous insulin infusion (CSII). This is paired with self-monitoring of blood glucose, which involves pricking the finger and manually testing blood samples multiple times per day, or increasingly with continuous glucose monitoring (CGM) devices, in which a sensor automatically measures interstitial glucose concentration at regular intervals. CGM reduces the need for painful finger sticks and provides more continuous insight into glycemic control vs self-monitoring of blood glucose. CGM devices have been shown to improve patient-reported and glycemic outcomes in PWT1D⁹ and include real-time CGM (rtCGM) systems, which store glucose measurements as they are transmitted, and intermittently scanned CGM (isCGM) systems, in which the user scans the sensor with a receiver or smartphone to view and store the data.

As an alternative to MDI, PWT1D may use insulin pumps, which can be integrated with rtCGM into a system with an algorithm that can automatically adjust or suspend insulin delivery based on sensor glucose levels. The latest innovation in these systems is advanced hybrid closed-loop (AHCL) technology, a function that delivers both auto basal and auto correction insulin. Most AHCL systems, including the MiniMed 780G system (MM780G; Medtronic Diabetes), have been shown to reduce hyperglycemia without increasing hypoglycemia.^10,11 Because persistent suboptimal glucose control increases the risk of diabetes complications,¹² AHCL is a potentially important means of controlling long-term costs and improving quality of life^13,14 among PWT1D.

The ADAPT study (NCT04235504) compared outcomes in PWT1D on MDI with isCGM who had suboptimal glucose control with those using the MM780G.⁵ After 6 months, mean hemoglobin A_1c (HbA_1c) levels had declined by 1.5% in the MM780G group compared with 0.2% in those using MDI with isCGM (P < .001). Significant differences at 6 months were also found in patient-reported outcomes, including treatment satisfaction (mean [SD] change in scores from baseline of 0.2 [6.8] for those on MDI with isCGM vs 6.1 [7.6] for MM780G users; P = .0003) and fear of hypoglycemia (mean [SD] change in scores from baseline of –2.7 [13.08] in the MDI-with-isCGM cohort vs –10.2 [15.51] in the MM780G cohort; P = .041).

The economic impact of older-generation insulin pumps compared with MDI has been studied in the US, with varying results.^15-17 This study evaluates the economic impact of an automated insulin delivery system with AHCL technology compared with MDI with isCGM using inputs from the ADAPT study.

METHODS

Model Description

Analyses were performed using the IQVIA Core Diabetes Model (CDM) version 9.5 Plus, a validated, proprietary model used to simulate long-term complication rates and cost-effectiveness of interventions for T1D and type 2 diabetes.^18,19 The CDM uses a series of Markov submodels to simulate the health states of individuals with diabetes based on their likelihood of complications. Simulated patients progress through the model based on their baseline characteristics and change in HbA_1c level from their assigned intervention, with costs and utilities determined based on their health states. Outcomes of the CDM include costs, quality-adjusted life expectancy (QALE) in years, and complication rates for each simulation cohort, as well as the incremental cost-effectiveness ratio (ICER; defined as the difference between costs in each cohort divided by the difference in QALE).

Simulation Cohort and Treatment Specifications

This is a secondary analysis using data from previous studies. Baseline cohort characteristics and change in HbA_1c level were sourced from the previously described ADAPT study. The mean (SD) age of the cohort at baseline was 41.50 (11.63) years, with a mean (SD) HbA_1c level of 9.00% (0.97%), and men represented 46% of study participants. Over the course of the 6-month study, the mean (SD) HbA_1c level decreased by 1.54% (0.73%) in the MM780G cohort and by 0.20% (0.80%) in the MDI-with-isCGM cohort.

Because of the limited duration of the ADAPT trial and the rarity of some adverse events, rates of hypoglycemic events and diabetic ketoacidosis (DKA) were sourced from the literature for the MDI-with-isCGM cohort. Severe hypoglycemic events (SHEs) were assumed to occur at a rate of 63.9 per 100 patient-years,²⁰ nonsevere hypoglycemic events at a rate of 1941.7 per 100 patient-years,²¹ and DKA at a rate of 2.6 events per 100 patient-years.²² Because the ADAPT study and others had no SHEs or DKA reported for PWT1D using the MM780G,^5,23-25 we assumed rates of these events in the MM780G cohort to be 50% of those in the MDI-with-isCGM group in the base case. This assumption results in DKA and SHE rates that are higher than those observed by Lablanche et al (although more information is needed to calculate exact rates from that study).²⁶ Separate sensitivity analyses assumed reductions in these events of 25% and 75% for the MM780G cohort vs the MDI-with-isCGM cohort. To evaluate uncertainty, 1000 bootstrap simulations were performed and cost-effectiveness acceptability curves were generated to assess the probability that the MM780G is cost-effective at a willingness-to-pay (WTP) threshold of $100,000, which is commonly accepted in the US.

Costs and Utilities

Analyses were performed from a payer perspective and included direct costs associated with diabetes complications, which were sourced from the literature and inflated to 2024 US$ (Table 1^15,27-33). Analyses were performed separately using 4-year and lifetime horizons, with the former based on the warranty period of the MM780G and average time spent with a commercial health insurer.³⁴ A 3% discount rate was applied to both cost and effectiveness inputs.³⁵

Treatment costs included the costs of insulin, insulin pumps and supplies (eg, infusion sets, reservoirs), CGM sensors and transmitters, and syringes and needles. In the MM780G group, treatment costs were estimated at $10,258.10 per patient per year, with the cost of the pump divided over the 4-year warranty period. In the MDI-with-isCGM group, treatment costs assumed that the isCGM used was the FreeStyle Libre 2 system (Abbott Diabetes Care). Treatment costs in this group were estimated at $4688.26 in the first year and $4604.26 in subsequent years, with the difference based on the cost of a one-time purchase of the FreeStyle Libre 2 Reader. Sensitivity analyses were performed, varying the cost of the MM780G by 10% in either direction.

Utilities and disutilities for more than 20 diabetes complication–related health states were sourced from the National Institute for Health and Care Excellence.²¹ Annual utilities associated with treatment were derived from the worry subscale of the Hypoglycemia Fear Survey (HFS). Because the ADAPT study did not keep participants on MDI with isCGM for 12 months, estimates for that cohort were taken from another study.²⁰ The ADAPT study found an improvement of 6.6 points on this HFS subscale in the MM780G group over 12 months,³⁶ and the FUTURE study (NCT02898714) found an improvement of 0.3 points in those on MDI with isCGM.²⁰ Because a 1-point improvement on this HFS subscale is associated with a 0.008 increase in the EQ-5D index measuring health-related utility,³⁷ we estimated utilities of 0.0528 and 0.0024 for the MM780G and MDI-with-isCGM treatments, respectively. In the base case, we assumed these to be annual utility benefits. A sensitivity analysis applied these utilities only to the first year of treatment.

RESULTS

Four-Year Horizon

In the base case, the MM780G was associated with an increase of 0.265 in QALE and $18,133.40 in total costs over 4 years compared with MDI with isCGM, resulting in an ICER of $68,402 per quality-adjusted life-year (QALY) gained (Table 2). At a WTP threshold of $100,000, there was a 98.1% chance of the MM780G being cost-effective vs MDI with isCGM (Figure [A]).

A sensitivity analysis assuming rates of SHEs and DKA being 25% lower in the MM780G group compared with those on MDI with isCGM showed that the MM780G had an ICER of $81,810 (Table 3). Conversely, if rates of SHEs and DKA were 75% lower in MM780G users vs the MDI-with-isCGM group, the resulting ICER was $57,626 (Table 3). At a WTP threshold of $100,000, the MM780G had an 85.9% and 100% probability of cost-effectiveness, respectively, relative to MDI with isCGM in these analyses.

Additional sensitivity analyses assessed the impact of price variations of the MM780G. After a 10% increase in price, the MM780G had an ICER of $77,258 per QALY, whereas a 10% decrease corresponded to an ICER of $56,411 (Table 3). At a WTP threshold of $100,000, these ICERs correspond to a 93.8% and 100% chance of cost-effectiveness, respectively.

A final sensitivity analysis applied the utility derived from the HFS survey only to the first year of treatment. Results show an ICER of $135,385 (Table 3). At a WTP threshold of $100,000, the MM780G had a 10.0% probability of cost-effectiveness. Therefore, the results from the 4-year analysis are not robust to changed assumptions around HFS utility, although they are robust to alternative assumptions around SHEs, DKA, and price changes assuming a WTP threshold of $100,000.

Because of the short horizon, between-group differences in projected incidence of long-term complications in the base case tended to be small (Table 4). However, there were some exceptions, including decreases of 7.29% in microalbuminuria, 7.51% in neuropathy, and 19.37% in background diabetic retinopathy for MM780G users compared with users of MDI with isCGM.

Lifetime Horizon

Over a lifetime horizon, the base-case analysis showed an increase of 1.817 in QALE and $70,572 in total costs in the MM780G group compared with those on MDI with isCGM (Table 2). The ICER in the base-case analysis was $38,842 per QALY. At a WTP threshold of $100,000 per QALY, there was a 100% chance of the MM780G being cost-effective vs MDI with isCGM (Figure [B]).

In a sensitivity analysis assuming 25% lower rates of SHEs and DKA in the MM780G group compared with those on MDI with isCGM, the MM780G was associated with an ICER of $45,565 per QALY (Table 3). In a sensitivity analysis assuming 75% lower rates of SHEs and DKA in MM780G users compared with those on MDI with isCGM, the MM780G was associated with an ICER of $33,582 (Table 3). At a WTP threshold of $100,000, there was a 100% chance of the MM780G being cost-effective vs MDI with isCGM in both sensitivity analyses.

Sensitivity analyses examining the effect of price variations found that a 10% increase in the price of the MM780G corresponded to an ICER of $44,953 for the MM780G, whereas a 10% price decrease resulted in an ICER of $30,569. Both ICERs were associated with a 100% probability of the MM780G being cost-effective vs MDI with isCGM at a WTP threshold of $100,000.

A separate sensitivity analysis applying the utility derived from the HFS tool to only the first year of treatment showed the MM780G had an ICER of $41,115 per QALY. At a WTP threshold of $100,000, there was a 100% chance of the MM780G being cost-effective vs MDI with isCGM. Assuming a WTP threshold of $100,000 per QALY, the analysis over a lifetime horizon is therefore robust to changes in assumptions around SHEs and DKA, pricing, and HFS-related utility.

Complication rates in the base case generally indicate a lower incidence of eye disease, renal disease, cardiovascular disease, ulcer, amputation, and neuropathy among MM780G users compared with those on MDI with isCGM (Table 4). Although some exceptions exist in which MDI with isCGM had a lower incidence of specific complications (eg, cataract, non–event-related fatality with or without history of complications), these differences were typically small. The model showed decreases of 30.56% in microalbuminuria, 20.95% in neuropathy, 33.62% in proliferative diabetic retinopathy, and 20.92% in severe vision loss among MM780G users compared with those using MDI with isCGM.

DISCUSSION

Insulin pump therapy is well established as a standard of care for PWT1D in the US; data from the T1D Exchange Registry show that 63% of PWT1D used an insulin pump between 2016 and 2018.³⁸ Previous assessments of the long-term cost-effectiveness of insulin pump therapy in the US were based on CSII therapy, which is not integrated with rtCGM and cannot make automatic adjustments to insulin delivery. Recent iterations of insulin pumps offer AHCL technology and have demonstrated superior clinical outcomes compared with MDI therapy as well as improvements over less-automated pump therapies (eg, CSII, sensor-augmented pump).^23,39 In addition, study findings have shown that AHCL technology in general¹¹ and compared with MDI¹³ or sensor-augmented pump with predictive low-glucose management¹⁴ improves quality of life, work-life satisfaction, and diabetes distress.

In this study, we demonstrate that AHCL technology is cost-effective over a lifetime and, in most cases, over the typical insulin pump warranty period of 4 years. Primary drivers of these findings include a significant reduction in HbA_1c levels and therapy-related quality-of-life improvements. Our results indicate that even in the 4-year warranty period, the MM780G treatment vs treatment with MDI and isCGM is cost-effective at WTP thresholds of $100,000 for all but 1 scenario, in which the utility associated with the HFS was applied only to the first year. These findings are especially relevant for payers because they must balance the need for effective patient treatment with value for health care dollars.

Similar analyses have examined the cost-effectiveness of the MM780G vs MDI with isCGM in different populations, including in PWT1D in Greece,⁴⁰ Sweden,⁴¹ Austria,⁴² and Singapore.⁴³ Our analysis has several similarities along with some key differences. Most notably, our study used the ADAPT trial⁵ to estimate changes in HbA_1c, offering the highest level of evidence to inform the model. Conversely, the Greece, Sweden, and Austria studies used separate studies that did not directly compare MDI with isCGM²⁰ and the MM780G^23,44 to estimate clinical effectiveness. Finally, rather than assume that the long-term rates of DKA and/or SHEs were zero in the MM780G group based on the results of limited-duration trials, we used the more conservative assumption that such events occurred at rates that were proportional to those in the MDI-with-isCGM group, and we performed sensitivity analyses varying those rates.

Limitations

This study has several limitations. First, we based the primary effectiveness end points on a study of European PWT1D with suboptimal glucose control (ie, HbA_1c levels of at least 8%). It is possible that the clinical outcomes observed in the ADAPT study are not directly transferable to the general population of PWT1D in the US, although real-world US studies showed similar time-in-range effects of the MM780G to those in ADAPT.^45,46

Further, we compared people on MDI with isCGM vs those on an insulin pump system that includes rtCGM. Prior study findings have shown that isCGM is associated with inferior glycemic outcomes compared with rtCGM^47,48 and with less improvement in the worry subscale of the HFS.⁴⁷ Because both change in HbA_1c and change in the HFS worry subscale (from which treatment utility is derived) are important factors in the simulation model, it is possible that an analysis comparing MDI with rtCGM vs the MM780G would result in different estimates of cost-effectiveness relative to the current study. An exploratory cohort from the ADAPT study that compared MDI with rtCGM vs the MM780G found smaller between-group changes in HbA_1c levels (although nonsignificant, due to limited sample size) relative to those observed when comparing MDI with isCGM vs the MM780G; changes in the HFS were not assessed.⁴⁹ In addition, it is possible that the increased cost of rtCGM compared with isCGM may partially offset any differences due to HbA_1c levels and HFS worry subscale scores.

We were unable to assess the economic value of the MM780G vs MDI with isCGM from a societal perspective due to lack of data on indirect costs. The ADAPT trial did not collect data on lost productivity, and literature-based estimates are not separated by treatment modality.⁵⁰ As a result, we were limited to assessing direct costs.

Finally, because the MM780G is a newer therapy, we lacked long-term data on its effectiveness over several years, particularly related to rates of hypoglycemia and DKA.

CONCLUSIONS

In this analysis, we estimated the cost-effectiveness of the MM780G compared with MDI with isCGM using a validated microsimulation model in PWT1D in the US. Although the ICER over a 4-year horizon was not cost-effective at a WTP threshold of $100,000 in 1 sensitivity analysis, in the base case and other sensitivity analyses, we found ICERs below $100,000. Moreover, cost-effectiveness improved over a lifetime horizon, in which we found the MM780G to be associated with ICERs below a WTP threshold of $100,000 in the base case and in 5 one-way sensitivity analyses. Despite higher treatment costs, substantial reductions in the incidence of long-term complications and improvements in quality of life make the MM780G a cost-effective alternative to MDI with isCGM in the US.

Acknowledgments

The MiniMed 780G system (or MiniMed AHCL system) algorithm includes technology developed by DreaMed Diabetes (Petah Tikva, Israel).

Author Affiliations: Formerly of Medtronic Diabetes (MK), Northridge, CA; Medtronic Inc (KW), Minneapolis, MN.

Source of Funding: The authors were employees of Medtronic while preparing this study.

Author Disclosures: Ms Kommareddi was previously employed by Medtronic Diabetes, and Dr Wherry is employed by and owns stock in Medtronic. Medtronic is the manufacturer of the device discussed in this article.

Authorship Information: Concept and design (MK, KW); acquisition of data (MK); analysis and interpretation of data (MK); drafting of the manuscript (MK); critical revision of the manuscript for important intellectual content (KW); and supervision (KW).

Address Correspondence to: Mallika Kommareddi, MPH, Medtronic Diabetes, 18000 Devonshire St, Northridge, CA 91325. Email: mallika.kommareddi@gmail.com.

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