OBJECTIVES: Hybrid closed loops (HCLs) are an up-and-coming management system for patients with Type 1 diabetes in the UK. An insulin pump and continuous glucose monitor are connected using a mathematical algorithm to automate more precise and timely deliveries of insulin, therefore substantially alleviating burden for these patients. In 2022, the EAG for the NICE TA10845 appraisal conducted an SLR to review the existing cost-effectiveness evidence surrounding HCLs. We aimed to update the SLR to assess whether newer studies continue to support evidence of cost-effectiveness.

METHODS: Using the same methodology published in NICE TA10845, the economic SLR was updated. The databases searched included MEDLINE®, Embase® and HTA websites (search period April 2022–June 2023). Screening was conducted by two independent reviewers. Outcomes of interest were extracted, such as model structure, cost/utilities information, model results and ICERs.

RESULTS: The results highlighted studies from countries including Wales, the US, Australia and Greece. The majority continued to show that HCL systems are a cost-effective option compared with current standard of care, with the limitation that this outcome is based on the use of different WTP thresholds. Unlike the original SLR, a study by Health Technology Wales found that HCLs were not a cost-effective treatment option. The models were shown to be sensitive to multiple variables, including the patient’s baseline HbA1c value, the definition of severe hypoglycaemic events, and treatment costs. These studies used a range of models, including the iQVIA CDM and Sheffield T1DM model.

CONCLUSIONS: Evidence to date supports the cost-effectiveness of HCLs for Type 1 diabetics across a wide range of geographies, while showing an improvement in the quality of life for these patients. Taking this evidence into account, further uptake of this technology may prove to be a beneficial choice for both the payer and the patient.