Cost-effectiveness of AID Use in Pregnant Women with T1D
Salima Azahaf, Kaat Beunen, Nancy Van Wilder, Dominique Ballaux, Gerd Vanhaverbeke, Youri Taes, Xavier-Philippe Aers, Frank Nobels, Liesbeth Van Huffel, Joke Marlier, Dahae Lee, Joke Cuypers, Vanessa Preumont, Sarah E. Siegelaar, Rebecca C. Painter, Annouschka Laenen, Pieter Gillard, Chantal Mathieu, Jeroen Luyten, and Katrien Benhalima
Cost-effectiveness of advanced hybrid closed loop therapy compared to standard insulin therapy for type 1 diabetes in pregnancy: an economic evaluation of the CRISTAL trial. ClinicalMedicine. 2025 Feb 14:81:103106.
Type 1 diabetes (T1D) during pregnancy demands tight glycaemic control to prevent serious complications including pre-eclampsia, caesarean sections, large-for-gestational-age infants, and neonatal intensive care admissions. Advanced hybrid closed loop (AHCL) systems have demonstrated clinical benefits in this setting, but their higher device costs raise questions about affordability. This study, conducted by researchers from Diabeter Centrum Amsterdam / Amsterdam UMC, KU Leuven, UZ Leuven,and centres across Belgium and the Netherlands, is the first economic evaluation of AHCL therapy compared to standard insulin therapy (SoC) specifically in pregnant women with T1D.
A decision tree model was developed using data from the CRISTAL trial — a multicentre randomised controlled trial comparing the MiniMed™ 780G AHCL system with SoC in 95 pregnant women with T1D. Total healthcare costs were estimated from the Belgian healthcare payer perspective over a 28-week time horizon, covering pregnancy through postpartum discharge. Uncertainty was explored through univariate and probabilistic sensitivity analyses, including 10,000 Monte Carlo simulations.
KEY FINDINGS
- AHCL therapy is cost-saving compared to SoC: Average total costs per patient were €13,989 with AHCL and €14,221 with SoC — a net saving of approximately €233 per individual. In the probabilistic sensitivity analysis, AHCL was both more effective and less costly in 73% of simulations.
- Fewer and shorter hospital admissions drive the savings: Patients in the AHCL group required hospitalisation for an average of 3 days per patient (total cost: €2,828), compared to 11.5 days in the SoC group (total cost: €10,842). These reduced hospitalisation costs fully offset the higher upfront cost of the MiniMed™ 780G device.
- Clinically meaningful glycaemic improvements were demonstrated: AHCL therapy provided an additional 24 minutes per night within the pregnancy-specific glucose target range, 19 fewer minutes per day and 7 fewer minutes per night spent in hypoglycaemia, and significantly improved treatment satisfaction.
- Cost savings are robust across multiple scenarios: When broader categories of diabetes-related hospitalisations were included, savings increased to up to €797 per patient, with AHCL dominant in 79–80% of simulations.
- The device cost threshold is well above the current price: At the observed SoC hospitalisation duration of 11.5 days, the MiniMed™ 780G price could rise to €5,331 before both strategies become equally costly — providing meaningful headroom above the current market price of €5,096.
- Results should be interpreted with caution: The CRISTAL trial was not statistically powered for the pregnancy outcomes modelled in this analysis. The dominance of AHCL should therefore be considered descriptive rather than inferential, and more robust data from larger studies and meta-analyses are needed.
This study provides the first evidence that AHCL therapy may not only improve clinical outcomes for pregnant women with T1D, but could also reduce the overall cost of care by lowering the burden of diabetes-related complications requiring hospitalisation. The findings offer a valuable foundation for healthcare decision-makers considering the implementation of AHCL systems in this population.
CONCLUDING THE AUTHORS STATE
".....AHCL therapy in T1D complicated pregnancies is associated with some clinical benefits, which might make it cost-effective from a Belgian healthcare payer perspective, despite the higher initial cost of the device. However, more robust data are needed on the potential impact of AHCL therapy on pregnancy and long-term health outcomes."
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