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Riemsma R, Corro Ramos I, Birnie R, et al. Integrated sensor-augmented pump therapy systems [the MiniMed® Paradigm™ Veo system and the Vibe™ and G4® PLATINUM CGM (continuous glucose monitoring) system] for managing blood glucose levels in type 1 diabetes: a systematic review and economic evaluation. Southampton (UK): NIHR Journals Library; 2016 Feb. (Health Technology Assessment, No. 20.17.)

Cover of Integrated sensor-augmented pump therapy systems [the MiniMed® Paradigm™ Veo system and the Vibe™ and G4® PLATINUM CGM (continuous glucose monitoring) system] for managing blood glucose levels in type 1 diabetes: a systematic review and economic evaluation

Integrated sensor-augmented pump therapy systems [the MiniMed® Paradigm™ Veo system and the Vibe™ and G4® PLATINUM CGM (continuous glucose monitoring) system] for managing blood glucose levels in type 1 diabetes: a systematic review and economic evaluation.

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Appendix 7Results (full incremental and intervention vs. comparator) of base-case and scenario analyses

TABLE 87

Base-case model results (all technologies) for probabilistic simulation

InterventionQALYsCost (£)Incremental QALYIncremental cost (£)ICER (£)
MDI + SMBG11.414661,050–––
CSII + SMBG11.975690,4360.56129,38652,381
MiniMed Veo system12.0412138,357Extendedly dominateda by stand-alone CSII + CGM
Stand-alone CSII + CGM12.0604146,4760.084956,039660,376
Integrated CSII + CGM (Vibe)12.0604147,150Dominated by stand-alone CSII + CGM
a

An extendedly dominated strategy has an ICER higher than that of the next most effective strategy.

TABLE 88

Base-case model results (intervention vs. comparator only) for probabilistic simulation

InterventionComparatorIncremental QALYIncremental cost (£)ICER (£)
MiniMed Veo systemMDI + SMBG0.626677,307123,375
MiniMed Veo systemCSII + SMBG0.065647,921730,501
MiniMed Veo systemStand-alone CSII + CGM–0.0192–8119422,849
Integrated CSII + CGM (Vibe)MDI + SMBG0.645886,100133,323
Integrated CSII + CGM (Vibe)CSII + SMBG0.084956,713668,789
Integrated CSII + CGM (Vibe)Stand-alone CSII + CGM0674Undefined

TABLE 89

Base-case model results (all technologies) for deterministic simulation

InterventionQALYsCost (£)Incremental QALYIncremental cost (£)ICER (£)
MDI + SMBG12.145062,927–––
CSII + SMBG12.725893,4330.580830,50652,524
MiniMed Veo system12.8087143,3090.082949,876601,641
Stand-alone CSII + CGM12.8223151,6710.01368363614,910
Integrated CSII + CGM
(Vibe)		12.8223152,372Dominated by stand-alone CSII+ CGM

TABLE 90

Base-case model results (intervention vs. comparator only) for deterministic simulation

InterventionComparatorIncremental QALYIncremental cost (£)ICER (£)
MiniMed Veo systemMDI + SMBG0.663780,382121,112
MiniMed Veo systemCSII + SMBG0.082949,876601,639
MiniMed Veo systemStand-alone CSII + CGM–0.0136–8363614,910
Integrated CSII + CGM (Vibe)MDI + SMBG0.677389,445132,061
Integrated CSII + CGM (Vibe)CSII + SMBG0.096558,939610,772
Integrated CSII + CGM (Vibe)Stand-alone CSII + CGM0701Undefined

TABLE 91

Model results (all technologies) for scenario with different baseline population characteristics

InterventionQALYsCost (£)Incremental QALYIncremental cost (£)ICER (£)
MDI + SMBG9.611765,070–––
CSII + SMBG10.099191,1890.487426,11953,588
MiniMed Veo system10.1474132,149Extendedly dominated by stand-alone CSII + CGM
Stand-alone CSII + CGM10.164139,1570.064947,967738,593
Integrated CSII + CGM (Vibe)10.164139,733Dominated by stand-alone CSII + CGM

TABLE 92

Model results (intervention vs. comparator only) for scenario with different baseline population characteristics

InterventionComparatorIncremental QALYIncremental cost (£)ICER (£)
MiniMed Veo systemMDI + SMBG0.535767,079125,217
MiniMed Veo systemCSII + SMBG0.048340,960848,028
MiniMed Veo systemStand-alone CSII + CGM–0.0166–7008422,148
Integrated CSII + CGM (Vibe)MDI + SMBG0.552374,663135,186
Integrated CSII + CGM (Vibe)CSII + SMBG0.064948,543747,971
Integrated CSII + CGM (Vibe)Stand-alone CSII + CGM0576Undefined

TABLE 93

Model results (all technologies) for scenario with two (CGM) vs. eight (SMBG) BG tests per day

InterventionQALYsCost (£)Incremental QALYIncremental cost (£)ICER (£)
MDI + SMBG11.414668,460–––
CSII + SMBG11.975698,0340.56129,57452,717
MiniMed Veo system12.0412138,357Extendedly dominated by stand-alone CSII + CGM
Stand-alone CSII + CGM12.0604146,4760.084948,441570,844
Integrated CSII + CGM (Vibe)12.0604147,150Dominated by stand-alone CSII + CGM

TABLE 94

Model results (intervention vs. comparator only) for scenario with two (CGM) vs. eight (SMBG) BG tests per day

InterventionComparatorIncremental QALYIncremental cost (£)ICER (£)
MiniMed Veo systemMDI + SMBG0.626669,897111,550
MiniMed Veo systemCSII + SMBG0.065640,323614,683
MiniMed Veo systemStand-alone CSII + CGM–0.0192–8119422,849
Integrated CSII + CGM (Vibe)MDI + SMBG0.645878,690121,849
Integrated CSII + CGM (Vibe)CSII + SMBG0.084949,116579,194
Integrated CSII + CGM (Vibe)Stand-alone CSII + CGM0674Undefined

TABLE 95

Model results (all technologies) for scenario with increased amount of daily insulin for MDIs

InterventionQALYsCost (£)Incremental QALYIncremental cost (£)ICER (£)
MDI + SMBG11.414662,114–––
CSII + SMBG11.975690,4370.561028,32350,487
MiniMed Veo system12.0412138,358Extendedly dominated by stand-alone CSII + CGM
Stand-alone CSII + CGM12.0604146,4760.084956,040660,376
Integrated CSII + CGM (Vibe)12.0604147,150Dominated by stand-alone CSII + CGM

TABLE 96

Model results (intervention vs. comparator only) for scenario with increased amount of daily insulin for MDIs

InterventionComparatorIncremental QALYIncremental cost (£)ICER (£)
MiniMed Veo systemMDI + SMBG0.626676,244121,679
MiniMed Veo systemCSII + SMBG0.065647,921730,501
MiniMed Veo systemStand-alone CSII + CGM–0.0192–8119422,849
Integrated CSII + CGM (Vibe)MDI + SMBG0.645885,036131,675
Integrated CSII + CGM (Vibe)CSII + SMBG0.084856,713668,789
Integrated CSII + CGM (Vibe)Stand-alone CSII + CGM0674Undefined

TABLE 97

Model results (all technologies) for scenario with no HbA1c progression

InterventionQALYsCost (£)Incremental QALYIncremental cost (£)ICER (£)
MDI + SMBG11.871558,520–––
CSII + SMBG12.455888,6630.584330,14351,615
MiniMed Veo system12.5228137,739Extendedly dominated by stand-alone CSII + CGM
Stand-alone CSII + CGM12.5398146,0760.084057,414683,889
Integrated CSII + CGM (Vibe)12.5398146,767Dominated by stand-alone CSII + CGM

TABLE 98

Model results (intervention vs. comparator only) for scenario with no HbA1c progression

InterventionComparatorIncremental QALYIncremental cost (£)ICER (£)
MiniMed Veo systemMDI + SMBG0.651379,219121,632
MiniMed Veo systemCSII + SMBG0.06749,076732,483
MiniMed Veo systemStand-alone CSII + CGM–0.017–8337490,424
Integrated CSII + CGM (Vibe)MDI + SMBG0.668388,247132,047
Integrated CSII + CGM (Vibe)CSII + SMBG0.08458,104691,715
Integrated CSII + CGM (Vibe)Stand-alone CSII + CGM0690Undefined

TABLE 99

Cost-effectiveness results when no treatment effect (in terms of change in HbA1c levels) is assumed in the first year (all technologies)

InterventionQALYsCost (£)Incremental QALYIncremental cost (£)ICER (£)
Stand-alone CSII + CGM12.0006146,632Dominated by MDI + SMBG
Integrated CSII + CGM (Vibe)12.0006147,304Dominated by MDI + SMBG
MDI + SMBG12.001656,928–––
CSII + SMBG12.01690,1780.014433,2502,309,028
MiniMed Veo system12.026138,5380.009948,3604,871,356

TABLE 100

Cost-effectiveness results when no treatment effect (in terms of change in HbA1c levels) is assumed in the first year (intervention vs. comparator only)

InterventionComparatorIncremental QALYIncremental cost (£)ICER (£)
MiniMed Veo systemMDI + SMBG0.024481,6103,344,672
MiniMed Veo systemCSII + SMBG0.009948,3604,871,356
MiniMed Veo systemStand-alone CSII + CGM0.0254–8093–318,634
Integrated CSII + CGM (Vibe)MDI + SMBG–0.000990,376–100,417,778
Integrated CSII + CGM (Vibe)CSII + SMBG–0.015457,126–3,709,460
Integrated CSII + CGM (Vibe)Stand-alone CSII + CGM0672Undefined

TABLE 101

Cost-effectiveness results if a RR of 0.125 is used for the MiniMed Veo system severe hypoglycaemic rate (all technologies)

Hypo MiniMed Veo system RRQALYsCost (£)Incremental QALYIncremental cost (£)ICER (£)
MDI + SMBG11.41260,812–––
CSII + SMBG11.959791,1950.547730,38355,474
MiniMed Veo system12.0453138,333Extendedly dominated by stand-alone CSII + CGM
Stand-alone CSII + CGM12.0604146,4760.100755,281549,080
Integrated CSII + CGM (Vibe)12.0604147,150Dominated by stand-alone CSII + CGM

TABLE 102

Cost-effectiveness results if a RR of 0.125 is used for the MiniMed Veo system severe hypoglycaemic rate (intervention vs. comparator only)

InterventionComparatorIncremental QALYIncremental cost (£)ICER (£)
MiniMed Veo systemMDI + SMBG0.633377,521122,408
MiniMed Veo systemCSII + SMBG0.085647,138550,675
MiniMed Veo systemStand-alone CSII + CGM–0.0151–8143539,295
Integrated CSII + CGM (Vibe)MDI + SMBG0.648486,338133,155
Integrated CSII + CGM (Vibe)CSII + SMBG0.100755,955555,659
Integrated CSII + CGM (Vibe)Stand-alone CSII + CGM0674Undefined

TABLE 103

Cost-effectiveness results for mortality due to severe hypoglycaemia scenario (all technologies)

InterventionQALYsCost (£)Incremental QALYIncremental cost (£)ICER (£)
MDI + SMBG11.104158,510–––
Stand-alone CSII + CGM11.7701142,215Dominated by CSII + SMBG
Integrated CSII + CGM (Vibe)11.7701142,872Dominated by CSII + SMBG
CSII + SMBG11.878189,4750.77430,96540,006
MiniMed Veo system12.0071137,8010.1298326374,531

TABLE 104

Cost-effectiveness results for mortality due to severe hypoglycaemia scenario (intervention vs. comparator only)

InterventionComparatorIncremental QALYIncremental cost (£)ICER (£)
MiniMed Veo systemMDI + SMBG0.902979,29187,818
MiniMed Veo systemCSII + SMBG0.129048,327374,626
MiniMed Veo systemStand-alone CSII + CGM0.2369–4413–18,622
Integrated CSII + CGM (Vibe)MDI + SMBG0.665984,362126,689
Integrated CSII + CGM (Vibe)CSII + SMBG–0.107953,397–494,418
Integrated CSII + CGM (Vibe)Stand-alone CSII + CGM0657Undefined

TABLE 105

Cost-effectiveness results for minimum QALY estimation method scenario (all technologies)

InterventionQALYsCost (£)Incremental QALYIncremental cost (£)ICER (£)
MDI + SMBG12.132761,050
CSII + SMBG12.586190,4360.453429,38664,813
MiniMed Veo system12.6408138,3570.054647,920876,987
Stand-alone CSII + CGM12.6462146,4760.060156,039932,305
Integrated CSII + CGM (Vibe)12.6462147,150Dominated by stand-alone CSII + CGM

TABLE 106

Cost-effectiveness results for minimum QALY estimation method scenario (intervention vs. comparator only)

InterventionComparatorIncremental QALYIncremental cost (£)ICER (£)
MiniMed Veo systemMDI + SMBG0.508177,307152,149
MiniMed Veo systemCSII + SMBG0.054747,921876,067
MiniMed Veo systemStand-alone CSII + CGM–0.0054–81191,503,465
Integrated CSII + CGM (Vibe)MDI + SMBG0.513586,100167,673
Integrated CSII + CGM (Vibe)CSII + SMBG0.060156,713943,649
Integrated CSII + CGM (Vibe)Stand-alone CSII + CGM0674Undefined

TABLE 107

Four-year time horizon scenario (all technologies)

InterventionQALYsCost (£)Incremental QALYIncremental cost (£)ICER (£)
MDI + SMBG2.77186706–––
Stand-alone CSII + CGM2.788224,803Dominated by CSII + SMBG
Integrated CSII + CGM (Vibe)2.788624,939Dominated by CSII + SMBG
CSII + SMBG2.790613,3650.01886659354,202
MiniMed Veo system2.792823,1440.002297784,461,063

TABLE 108

Four-year time horizon scenario (intervention vs. comparator only)

InterventionComparatorIncremental QALYIncremental cost (£)ICER (£)
MiniMed Veo systemMDI + SMBG0.021016,438782,762
MiniMed Veo systemCSII + SMBG0.002297794,445,000
MiniMed Veo systemStand-alone CSII + CGM0.0046–1659–360,652
Integrated CSII + CGM (Vibe)MDI + SMBG0.016818,2331,085,298
Integrated CSII + CGM (Vibe)CSII + SMBG–0.002011,574–5,787,000
Integrated CSII + CGM (Vibe)Stand-alone CSII + CGM0.0004136340,000

TABLE 109

Cost-effectiveness results for fear of hypoglycaemia scenario (all technologies)

InterventionQALYsCost (£)Incremental QALYIncremental cost (£)ICER (£)
MDI + SMBG11.414661,050–––
CSII + SMBG11.975690,4360.561029,38652,381
Stand-alone CSII + CGM12.0604146,476Extendedly dominated by MiniMed Veo system
MiniMed Veo system12.6224138,3570.646847,92074,088
Integrated CSII + CGM (Vibe)12.6429147,1500.02058792428,595

TABLE 110

Cost-effectiveness results for fear of hypoglycaemia scenario (intervention vs. comparator only)

InterventionComparatorIncremental QALYIncremental cost (£)ICER (£)
MiniMed Veo systemMDI + SMBG1.207777,30764,012
MiniMed Veo systemCSII + SMBG0.646847,92174,088
MiniMed Veo systemStand-alone CSII + CGM0.5619–8119–14,448
Integrated CSII + CGM (Vibe)MDI + SMBG1.228286,10070,103
Integrated CSII + CGM (Vibe)CSII + SMBG0.646847,92174,089
Integrated CSII + CGM (Vibe)Stand-alone CSII + CGM0.58246741157

TABLE 111

Cost-effectiveness results for cost of stand-alone CSII + CGM without market share scenario (all technologies)

InterventionQALYsCost (£)Incremental QALYIncremental cost (£)ICER (£)
MDI + SMBG11.414661,050–––
CSII + SMBG11.975692,2720.56131,22255,654
MiniMed Veo system12.0412138,357Extendedly dominated by Integrated CSII + CGM
Integrated CSII + CGM (Vibe)12.0604147,1500.084954,878646,692
Stand-alone CSII + CGM12.0604150,063Dominated by integrated CSII + CGM

TABLE 112

Cost-effectiveness results for cost of stand-alone CSII + CGM without market share scenario (intervention vs. comparator only)

InterventionComparatorIncremental QALYIncremental cost (£)ICER (£)
MiniMed Veo systemMDI + SMBG0.626677,307123,375
MiniMed Veo systemCSII + SMBG0.065646,086702,530
MiniMed Veo systemStand-alone CSII + CGM–0.0192–11,705609,635
Integrated CSII + CGM (Vibe)MDI + SMBG0.645886,100133,323
Integrated CSII + CGM (Vibe)CSII + SMBG0.084854,878647,146
Integrated CSII + CGM (Vibe)Stand-alone CSII + CGM0–2913Undefined
Copyright © Queen’s Printer and Controller of HMSO 2016. This work was produced by Riemsma et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

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