Researchers conducted a multicenter real-world evidence (RWE) analysis. They evaluated the cost-effectiveness of Automated Insulin Delivery (AID) systems in resource-limited settings across India. This study focused on patients with type 1 diabetes. It incorporated high-carbohydrate diets common in Indian diets. Additionally, it addressed rural access barriers.
Investigators used lifetime Markov modeling. They compared AID systems to standard care like multiple daily injections (MDI) plus intermittent CGM or basic pumps. Data came from Indian cohorts and adapted global trials. Key outcomes included HbA1c reduction, time-in-range improvement, and fewer hypoglycemic events.
Clinical benefits emerged strongly. AID systems increased time-in-range by 10-20%. They reduced severe hypoglycemia episodes. Patients experienced fewer hospitalizations for ketoacidosis. These gains translated to better quality-adjusted life years (QALYs).
Incremental cost per QALY favored AID in projections. Upfront costs rose due to device and sensor expenses. However, long-term savings offset this. Reduced complications lowered direct medical costs. Indirect savings came from preserved productivity. In adapted LMIC scenarios, incremental costs per QALY ranged from $5,000 to $15,000 (adjusted for India). This fell below common willingness-to-pay thresholds in resource-limited contexts.
High-carbohydrate diets posed challenges. Traditional Indian meals spike postprandial glucose. AID algorithms adjusted insulin delivery dynamically. This mitigated excursions better than manual methods. Real-world data showed sustained TIR despite dietary patterns.
Rural access barriers limited adoption. High initial costs deterred uptake. Electricity and internet instability affected connectivity. Supply chain issues delayed sensor replacements. Training gaps existed in remote areas. Policymakers need subsidies and infrastructure support.
Sensitivity analyses confirmed robustness. Probabilistic simulations showed AID cost-effective in over 80% of cases. Key drivers included device price reductions and complication avoidance.
Overall, AID systems prove promising. They offer good value in India despite constraints. Policymakers should prioritize affordability programs. Rural telemedicine integration helps overcome barriers. Consult healthcare experts for individual decisions.