Assessment of the added value of a tubeless pump: a time trade-off (TTO) study for utility elicitation of insulin delivery systems in type 1 diabetes mellitus (T1D)

Introduction

Automated insulin delivery (AID) systems continuously deliver insulin subcutaneously, reducing the burden of managing type 1 diabetes mellitus (T1D). However, there are limited data comparing different insulin delivery modalities, particularly regarding their impact on health-related quality of life (HRQoL). This study aimed to quantify the disutility associated with conventional insulin delivery modalities and utility gains associated with wearable, on-body, AID systems.

Methods

Health state vignettes representing different insulin delivery modalities were developed based on interviews with people with T1D alongside published literature and validated by experts. Utility values were elicited via the time trade-off (TTO) method from the general population in the United Kingdom (UK) (n = 110).

Results

The lowest mean utility values were observed for tubed non-AID systems (0.727), while the highest mean utility value was observed for tubeless systems with AID (0.909). The use of tubeless systems rather than tubed systems was associated with a significant increase in utility between + 0.082 and + 0.086 (p < 0.005), and the use of AID was associated with a significant increase in utility of between +0.096 and +0.100 versus the corresponding alternatives (p < 0.0005). The use of a tubeless and AID system was associated with a significantly increased utility versus all other health states (p < 0.0001), indicating significantly higher HRQoL.

Conclusion

This study elicited utility values for health states representing insulin delivery modalities in T1D. Results suggested that tubeless and AID systems are associated with higher health state utility in T1D, indicating that people with T1D using such systems may experience improved HRQoL.