Type 1 diabetes is an autoimmune condition in which the pancreas produces little or no insulin, requiring people to manage their glucose through external insulin for life. More than 121,000 Australians live with the condition, and roughly 3000 new cases are diagnosed each year. Over decades, persistently elevated glucose damages small blood vessels, driving complications such as retinopathy, neuropathy, and kidney disease. Recent Australian data estimate average annual direct healthcare costs of AUD 7084 per person with type 1 diabetes, more than two and a half times the AUD 2789 spent on people without diabetes, and the 2022 Australian National Diabetes Audit identified peripheral neuropathy and retinopathy as the most frequently reported complications, with rates climbing as the duration of disease lengthens.

Automated insulin delivery systems represent the newest generation of diabetes technology. These hybrid closed-loop devices link a continuous glucose monitor to an insulin pump via a control algorithm that adjusts insulin dosing every few minutes, mimicking some of the feedback function of a healthy pancreas. A 2024 consensus statement convened and endorsed by Diabetes Australia and numerous other societies declared automated insulin delivery the standard of care and recommended that all Australians with type 1 diabetes should have access to it. Yet fewer than 20 percent of people with the condition in Australia currently use such systems, largely because of cost and the limited funding arrangements available to adults outside top-tier private health insurance.

The new analysis focused on the MiniMed 780G advanced hybrid closed-loop system and compared it with the combination of multiple daily injections and continuous glucose monitoring. Clinical inputs came from the ADAPT randomized controlled trial, a European study in adults with type 1 diabetes and baseline HbA1c of at least 8.0 percent. In that trial, participants using the MiniMed 780G achieved a mean reduction in HbA1c of 1.54 percentage points from a baseline of 9.04 percent, while those on injections plus glucose monitoring achieved only a 0.20 percentage point reduction. The researchers assumed that intermittently scanned and real-time continuous glucose monitors had equivalent HbA1c efficacy, an assumption supported by published meta-analyses, though the modeling restricted treatment effects to HbA1c differences alone.

The simulation used the IQVIA Core Diabetes Model, an established platform for projecting long-term outcomes in diabetes. The model consists of multiple interdependent Markov sub-models covering both acute events and chronic complications, run through patient-level Monte Carlo simulations with tracker variables allowing the sub-models to interact. Physiological parameters such as HbA1c drive individual event risks and progress naturally over time based on long-term epidemiological studies. The simulated cohort reflected Australian registry data, with a mean baseline age of 43.3 years and a mean diabetes duration of 20.3 years. The base case analysis took a public healthcare payer perspective, captured only direct costs, ran over a 50-year horizon, and applied the 5 percent annual discount rate that Australian health economic guidance requires for future costs and outcomes.

The base case results showed that long-term use of the MiniMed 780G was projected to yield 13.32 quality-adjusted life years compared with 11.81 for injections plus monitoring, a difference of 1.51 quality-adjusted life years. Lifetime direct costs were higher with the technology, at AUD 367,341 versus AUD 317,819, driven mainly by device acquisition and consumable expenses. However, complication costs ran in the opposite direction, falling for users of the automated system because fewer people progressed to diabetes-related damage. The resulting incremental cost-effectiveness ratio was AUD 32,840 per quality-adjusted life year gained, well below the AUD 50,000 per quality-adjusted life year threshold that more than 60 percent of Australian cost-utility analyses published between 1992 and 2022 have assumed, even though Australia has no official willingness-to-pay threshold.

The projected clinical benefits extended across nearly every complication category. Simulated users of the automated system spent 1.15 years longer free of any diabetes-related complication, a 128 percent increase, with the largest gains seen in microvascular outcomes: 9.67 additional years free of macular edema, 8.20 years free of proliferative retinopathy, 7.58 years free of microalbuminuria, 6.25 years free of neuropathy, and 5.78 years free of severe vision loss. These delays translated into meaningful savings, including AUD 18,882 less in ulcer, amputation, and neuropathy costs, AUD 15,323 less in eye complication costs, AUD 8150 less in cardiovascular costs, and AUD 5428 less in renal costs over a lifetime.

Sensitivity analyses underscored how strongly the result depends on the long view. Over shorter horizons of 10 to 15 years, the incremental cost-effectiveness ratio exceeded AUD 50,000 per quality-adjusted life year, likely because many diabetes complications take decades to develop, so the savings and quality-of-life gains from preventing them only accumulate late. The analysis was also sensitive to the inclusion of hypoglycemic event rates and to the quality-of-life benefit associated with reduced fear of hypoglycemia, which the ADAPT trial had quantified. When that fear-related utility benefit of 0.0544 annually for the automated system was removed entirely, the ratio rose to AUD 55,976 per quality-adjusted life year, pushing the result above the conventional threshold. Conversely, adding severe hypoglycemic events and diabetic ketoacidosis lowered the ratio to AUD 19,234 per quality-adjusted life year, since preventing these acute crises avoids expensive emergency care.

A secondary analysis from the societal perspective, which incorporated indirect costs such as lost productivity from absenteeism using the human capital approach, made the case for the technology even stronger. Without hypoglycemia and ketoacidosis included, the societal-perspective ratio was AUD 23,378 per quality-adjusted life year; with those events included, it fell to just AUD 9446. Previous research has shown that even non-severe hypoglycemic episodes impair workplace productivity, and Australian users of advanced glucose technologies report in community surveys that the devices ease limitations on eating, sleeping, exercising, and socializing while improving emotional well-being. Severe hypoglycemic events causing loss of consciousness can also trigger temporary suspension of a person’s driving license in Australia, a consequence that compounds the personal burden beyond anything a cost model can capture.

The authors acknowledge limitations, including the reliance on a European trial, the assumption of equivalent HbA1c efficacy between glucose monitor types, the exclusion of complications not captured in the model such as oral, hearing, and autonomic effects, and the restriction to people with baseline HbA1c above 8.0 percent. Even so, real-world Australian studies, including a multicenter Queensland evaluation showing that starting automated insulin delivery improved time in range and HbA1c, particularly for those with higher baseline levels, support the generalizability of the findings. With the Australian Government’s Insulin Pump Program currently means-tested for people under 21, and Diabetes Australia and a 2024 parliamentary committee report both calling for stepwise expansion of access, the analysis concludes that broader funding of automated insulin delivery for adults with above-target HbA1c would improve long-term outcomes and likely represent an efficient use of healthcare resources.

Subject of Research: Long-term cost-effectiveness of advanced hybrid closed-loop automated insulin delivery versus multiple daily injections with continuous glucose monitoring in Australian adults with type 1 diabetes

Article Title: Long-Term Cost-Effectiveness of an Advanced Hybrid Closed-Loop Automated Insulin Delivery System Versus Multiple Daily Insulin Injections Plus Continuous Glucose Monitoring in Adults with Type 1 Diabetes in Australia

Article References: Glastras, S., Read, M., Ozdemir Saltik, A. Z., Huynh, M., Challis, G., Hill, M., Field, M., Pollock, R., & de Portu, S. (2026). Long-Term Cost-Effectiveness of an Advanced Hybrid Closed-Loop Automated Insulin Delivery System Versus Multiple Daily Insulin Injections Plus Continuous Glucose Monitoring in Adults with Type 1 Diabetes in Australia. Advances in Therapy. https://doi.org/10.1007/s12325-026-03752-8

Image Credits: AI Generated

DOI: 10.1007/s12325-026-03752-8

Keywords: type 1 diabetes, automated insulin delivery, hybrid closed-loop, MiniMed 780G, cost-effectiveness, continuous glucose monitoring, health economics, Australia, HbA1c, quality-adjusted life years, diabetes complications, IQVIA Core Diabetes Model