# Minimed 780G who’s got one?



## Type1derful

Who has been fortunate enough to receive this pump? Is it available via NHS or is it self funding only ? I am patiently waiting for pump meetings to restart so that I can get one.  Initially liking the omnipod however the minimed 780g seems like a god send !! What are peoples thoughts


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## grovesy

I am not a pump user but the availability of various pump makes varies from area to area.


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## SB2015

I will start on my 780 on 14 Dec.  I am having to self fund the sensors but that will not be until January once we have got used to the pump in manual mode, which we would need to revert to if the sensor fails.


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## Paulbreen

I live in Germany and I have a 670G and CGM it’s a great system but takes some patience to learn it, I almost gave up more than once in the last 18months I have it, I’m just waiting for the 780G which I think will fix the small issues with mine


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## Type1derful

SB2015 said:


> I will start on my 780 on 14 Dec.  I am having to self fund the sensors but that will not be until January once we have got used to the pump in manual mode, which we would need to revert to if the sensor fails.


How much will that cost you to do this if you don’t mind me asking ?


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## SB2015

Type1derful said:


> How much will that cost you to do this if you don’t mind me asking ?


It will cost about £50 per week, unless I feel confident enough to restart sensors which I know some people do, and make them last a lot longer.

I self funded the Libre in the early days, and then got it on the NHS after about 18 months.
I shall be gathering the data around the impact of the CGM on me, and will watch to see if these eventually become more available in the NHS, and for me to see if the benefits justify the cost.  For me it is more about have to think about my Diabetes a lot less, having more flexibility and getting more sleep. If no funding is available I can’t think of any thing better to spend my pension on.


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## SB2015

Ps
I have also found that my phone is not compatible with the app needed for the pump so need to lay out for that as well.  That wasn’t part of the plan, but will still go ahead with it.


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## Type1derful

SB2015 said:


> Ps
> I have also found that my phone is not compatible with the app needed for the pump so need to lay out for that as well.  That wasn’t part of the plan, but will still go ahead with it.


Oh really ? I thought it would be compatible with most phones that is frustrating but hopefully you can find a solution.. I definitely agree with your previous post. I am still going to ask my nurse and see what the availability for the 780g is but I don’t think it’s available in my area yet as nobody has mentioned it to me as of yet.  I’m interested to see how you get on with it so look forward to your posts


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## Paulbreen

SB2015 said:


> It will cost about £50 per week, unless I feel confident enough to restart sensors which I know some people do, and make them last a lot longer.
> 
> I self funded the Libre in the early days, and then got it on the NHS after about 18 months.
> I shall be gathering the data around the impact of the CGM on me, and will watch to see if these eventually become more available in the NHS, and for me to see if the benefits justify the cost.  For me it is more about have to think about my Diabetes a lot less, having more flexibility and getting more sleep. If no funding is available I can’t think of any thing better to spend my pension on.


On the whole thes sensors are ok but not fantastic, I use their guardian 3 sensor and they have been known to fail now and then I would say don’t expect a Libre style sensor, fit and forget.
if they dislodge at all you can expect a lot of wasted time waiting for them to calibrate only for your pump to tell you to change it after 5 hours. For some reason during the day they are great but during the night everything seems to happen, kicked out of auto mode because of wanting a BG when it was calibrated 4 hours ago is one that seems to plague me at the moment.
I heard a new one is on the horizon that deals with the issues people are reporting but we will have to see what hurdles the FDA put up for it to become reality


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## MrDaibetes

I use the 670g with funded sensors. I did want to try and upgrade early, but with backlog on pumps, I am giving time, before I push for an upgrade.


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## SB2015

MrDaibetes said:


> I use the 670g with funded sensors. I did want to try and upgrade early, but with backlog on pumps, I am giving time, before I push for an upgrade.


Am I right in thinking that

The sensor is ‘talking’ to the pump
The pump ‘talks’ to your phone, so if I get a phone that links with the pump it won’t matter what sensors I will be using
Also if I don’t have my phone with me all the time, does the phone gather up the data from that gap when the pump and phone get back together again?

I am sure these things will become clear and seem like silly questions once I have got going but ....


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## daducky88

Type1derful said:


> Who has been fortunate enough to receive this pump? Is it available via NHS or is it self funding only ? I am patiently waiting for pump meetings to restart so that I can get one.  Initially liking the omnipod however the minimed 780g seems like a god send !! What are peoples thoughts


Ive got a 740g but nhs rationing doesnt permit me one.
Its disheartening as you wonder what what the point of helpful tech is if you cant get it.


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## daducky88

SB2015 said:


> It will cost about £50 per week, unless I feel confident enough to restart sensors which I know some people do, and make them last a lot longer.
> 
> I self funded the Libre in the early days, and then got it on the NHS after about 18 months.
> I shall be gathering the data around the impact of the CGM on me, and will watch to see if these eventually become more available in the NHS, and for me to see if the benefits justify the cost.  For me it is more about have to think about my Diabetes a lot less, having more flexibility and getting more sleep. If no funding is available I can’t think of any thing better to spend my pension on.


"...anything better to spend my pension on"

Beers, chips and gravy?


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## daducky88

daducky88 said:


> "...anything better to spend my pension on"
> 
> Beers, chips and gravy?


Or maybe you're a curry sauce man?
I always have trouble choosing.. Guess you can have both and as we're not complete philistines here, i would not suggest mixing them, but rather dipping one end in gravy, and tge other in curry sauce.  I know, i know, delusions of adequacy. i'll never live them down now.


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## daducky88

Paulbreen said:


> I live in Germany and I have a 670G and CGM it’s a great system but takes some patience to learn it, I almost gave up more than once in the last 18months I have it, I’m just waiting for the 780G which I think will fix the small issues with mine


Hi Paul

Hows the funding for your pumps etc structured? Does Germ.demand copayment or is all covered under a co ins. scheme?


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## Paulbreen

In Germany everyone has health insurance, either statutory or private, most have statutory version which is more or less the same as the UK  national insurance you pay from your salary, I think it’s a little more than NI contribution. 
We pay a small fee for prescriptions the same way as you but it depends on the item how much you pay but I would say it’s cheaper than the UK. For instance when I used the freestyle Libre I paid €10 per month for them.
The health insurance companies seem interested to give you the best technology if it’s improving your overall health. For all the Meditronic items I have, pump, sensors I pay about €12 per month


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## daducky88

Paulbreen said:


> In Germany everyone has health insurance, either statutory or private, most have statutory version which is more or less the same as the UK  national insurance you pay from your salary, I think it’s a little more than NI contribution.
> We pay a small fee for prescriptions the same way as you but it depends on the item how much you pay but I would say it’s cheaper than the UK. For instance when I used the freestyle Libre I paid €10 per month for them.
> The health insurance companies seem interested to give you the best technology if it’s improving your overall health. For all the Meditronic items I have, pump, sensors I pay about €12 per month


I think thats cheaper than england where you get the pump and pump consumables free if you qualify, but may/ may not qualify for free sensors which ocountries.otherwise cost £120/ month onnself pay, so 10x more than Germany.
The key aspect of the uk health system.is a pokicy rationing of goods/ services as nhs funding pp did not match pop growth + clinicial prioritisation by severity leading to an underserved middle of road chronic patuent population fir T1D.
By contrast, my experience of German system of a multitude private insurance schemes is it might be responsible for a lower level of systemic competence.  I used to live in Germany and for 2 years, they failed to diagnose a rare autoimm disease despite multiple A+E and o/ n hosp visits.  By contrast, within half an hour of being delivered via A+E to Trundle + Waddington ward of Kings College London, they diagnosed the disease. 
I recognise that a sample of 1 is not statistically meaningful.  However meaningful or not, if i-d stayed in Germany, in all calmness, it would been the end of me.

Maybe someones conducted an international comparison of undiagnosed mortality rates between countries.


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## Paulbreen

I would say once the technology is proven, it’s early days, the powers than be will realise the benefits of closed loop treatment, I’m 85-95% in my target range since using the pump, the health benefit of that kind of result will save them millions on treating diabetic related illnesses


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## daducky88

Of course the total is an interesting study in affordability and efficiency

Eg
*Assumptions
UK*
Mean salary £28k
Modal salary £13.2k (IFS 2018)
UK 11% NI and say £1200pa vs mean gross salary =+4.3% 
= 15.3 gross national mean salary
= 20% gross national modal salary

*Germany*
Mean salary €26k
Modal salary €20k
German salary shows less skew to extremes than the UK.

12%-20%? health insurance, call it 16% on av and €144 sensors
= 16.4 of gross natnl mean salary
=16.6% of gross natnl modal salary 

*Conc*
Thus the German system is more expensive than the British for higher earners and less expensive than the British system for lower earners.


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## SB2015

So apart from the interesting suggestions of what else to spend my pension on, and comparisons between the costs of the system, ....

I urgently need to buy my new phone before my pump start training so can anyone answer these questions:

I never use a contract to buy my phones as I don’t use much data and  don’t do big downloads etc so the contracts mean I am paying for  a lot more than I need.  *How much data do I need to allow for the links to my phone*?  This is probably similar on any CGM system so any advice welcome (@everydayupsanddowns , @Stitch147 , @MrDaibetes ...)
Am I right in thinking that my phone only needs to be compatible with the pump, the sensor won’t matter.  I don’t want to have to buy another phone if I change to the next sensors in the future.
Also if I don’t have my phone with me all the time, does the phone gather up the data from that gap when the pump and phone get back together again?


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## Paulbreen

SB2015 said:


> So apart from the interesting suggestions of what else to spend my pension on, and comparisons between the costs of the system, ....
> 
> I urgently need to buy my new phone before my pump start training so can anyone answer these questions:
> 
> I never use a contract to buy my phones as I don’t use much data and  don’t do big downloads etc so the contracts mean I am paying for  a lot more than I need.  *How much data do I need to allow for the links to my phone*?  This is probably similar on any CGM system so any advice welcome (@everydayupsanddowns , @Stitch147 , @MrDaibetes ...)
> Am I right in thinking that my phone only needs to be compatible with the pump, the sensor won’t matter.  I don’t want to have to buy another phone if I change to the next sensors in the future.
> Also if I don’t have my phone with me all the time, does the phone gather up the data from that gap when the pump and phone get back together again?


Here’s a link I’m sure you may have see for it






						MiniMed™ 780G system | Medtronic Diabetes
					

Our most advanced insulin pump system. Automatically* adjust insulin delivery and corrects glucose levels every 5 mins, 24/7with no fingersticks*†.




					www.medtronic-diabetes.co.uk
				




From what I have read the pump is working with Bluetooth so you phone with the app will be connected with the pump, as I understand it the communication is one way so the pump will inform the phone app with status info but you can’t control the pump from the phone. 
I would think the sensor is only talking to the pump as I believe you would be using the guardian 3 sensors that I use and they only communicate with the pump.


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## Paulbreen

daducky88 said:


> Of course the total is an interesting study in affordability and efficiency
> 
> Eg
> *Assumptions
> UK*
> Mean salary £28k
> Modal salary £13.2k (IFS 2018)
> UK 11% NI and say £1200pa vs mean gross salary =+4.3%
> = 15.3 gross national mean salary
> = 20% gross national modal salary
> 
> *Germany*
> Mean salary €26k
> Modal salary €20k
> German salary shows less skew to extremes than the UK.
> 
> 12%-20%? health insurance, call it 16% on av and €144 sensors
> = 16.4 of gross natnl mean salary
> =16.6% of gross natnl modal salary
> 
> *Conc*
> Thus the German system is more expensive than the British for higher earners and less expensive than the British system for lower earners.


Your conclusion is pretty accurate, in Germany the more you earn the more you pay and the lower earners still get the same level of care but their monthly deductions are a lower percentage of their salary. Even though you pay your health insurance to a private company the government sets the rules they operate with regarding premiums. I pay are maximum percentage which is 13.3% at the moment also there is a threshold of €4200 per month where you don’t pay more insurance if you earn more than that.


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## SB2015

Paulbreen said:


> Here’s a link I’m sure you may have see for it
> 
> 
> 
> 
> 
> 
> MiniMed™ 780G system | Medtronic Diabetes
> 
> 
> Our most advanced insulin pump system. Automatically* adjust insulin delivery and corrects glucose levels every 5 mins, 24/7with no fingersticks*†.
> 
> 
> 
> 
> www.medtronic-diabetes.co.uk
> 
> 
> 
> 
> 
> From what I have read the pump is working with Bluetooth so you phone with the app will be connected with the pump, as I understand it the communication is one way so the pump will inform the phone app with status info but you can’t control the pump from the phone.
> I would think the sensor is only talking to the pump as I believe you would be using the guardian 3 sensors that I use and they only communicate with the pump.


Thanks Paul.

I am getting my head round things step by step.
As I have to buy a new phone I want to make sure I don’t get that wrong.


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## SB2015

@Paulbreen do you restart sensors with your 670 or just stick to the 7 day life of them.


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## SB2015

I found out today, that the three of us being started on the 780 in a cou0ke of week’s time are the first ones in this area.  So the DSN is learning with us too, which is fine as he is happy to have the endless questions from us and we are all helping each other.


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## grovesy

Re your phone I usally buy my phones unlocked, and I have a SIM only contract.


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## Paulbreen

SB2015 said:


> @Paulbreen do you restart sensors with your 670 or just stick to the 7 day life of them.


I’m just using them for the 7Days at the moment as they are a bit temperamental and I don’t have a problem with supply of them as my insurance pays for them, I’m a bit of a software guy so I’ll eventually take a closer look at them out of curiosity. 
look for a YouTube channel called Type one talks, the guy there can be a little hard to listen too but he is very much into sharing how to extend sensor life and stuff like that, I know he has his libre sensors working for a month now, I don’t recommend doing it but it can be done


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## daducky88

Paulbreen said:


> I would say once the technology is proven, it’s early days, the powers than be will realise the benefits of closed loop treatment, I’m 85-95% in my target range since using the pump, the health benefit of that kind of result will save them millions on treating diabetic related illnesses


I hope you're right.
However as future benefit e.g. morbidity avoided, survival extended is discounted due to preference for spending now, but the cost is incurred before as well as during the benefit period, this will put a higher demand on size of beneficial effect in addition to tge high on going costs of treatment with fancy kit.

As fag packet calc
Eg for a 26 yr old living til 71 assuming 10 yrs reduction in life on average on mdi

*On multiple daily injections*
Fixed Costs =£200
(Pen injector x2 £100 = £200
Glycaemia testor £0 )

*Recurrent Costs £ pa*
Disposable needle tips.             pa £50
Insulin detemir £42/1500U =365*20U/day*42/1500.          =£204pa
Insulin humalog £30/1500U.  = £146pa
Blood test strips 6 / day +365*£15/50.                                                         =£657pa
Glucagon 4 pa +£11.52/mg = £46pa
2A+E visits pa. 2x250.           =£500pa
1 o/n hospitalisatn pa.          £1600pa

Consultancy Fees
Diabetic + opthamology 6 mnthly.                                                             £1000pa
estimate- i dont what these really cost

Total per patient
One off. £200
Recurrent: £4203pa
*Lifetime £                               = £0.189M
Quality Adjusted Yrs =45* 0.60 = 27
Survival =                                       45 yrs

----
pump.no sensor*

Fixed Costs =£3000
(Pump £3000
Glycaemia testor £0 )

*Recurrent Costs £ pa*
Plastics
Canula £9.80 each, 3 days dur=9.8×365/3=                        £1192pa
Reservoirs £2.90 each, 3 says dur = 2.9x365/3=                                 £353pa

Insulin humalog 40U/ day £16/1000U =                                                           £234pa
Blood test strips 6 / day +365*£15/50=                                                            £657pa
Glucagon 2 pa +£11.52/mg =        £23pa
2 paramed visits pa. 2x125 =       £250pa
est.


Consultancy Fees
Diabetic + opthamology 6 mnthly est.                                                             £1000pa


Total
One off. £3000
Recurrent: £3709pa
*Lifetime £ =                   .           £0.188M 
Quality Adjusted Yrs =50* 0.66 = 33
Survival =                          .   .    . 50yrs

---

AI System*

Fixed Costs =£5500
(Pump £5500 est )

*Recurrent Costs £ pa*
Plastics
Canula £9.80 each, 3 days dur=9.8×365/3=                        £1192pa
Reservoirs £2.90 each, 3 says dur = 2.9x365/3=                                 £353pa

Insulin humalog 40U/ day £16/1000U =                                                           £234pa
Sensor                                                                                                                   £1200pa
Glucagon 0.25 pa +£11.52/mg =                                                                      £2.88pa
0.25 pa paramed visits pa. 0.25x125.                                                        =£31.25pa


Consultancy Fees
Diabetic + opthamology 12 mnthly est.                                                             £500pa
Total
One off. Est  £5500
Recurrent: £3513pa
*Lifetime £ =                             £0.199M
Quality Adjusted Yrs =55* 0.8 = 44
Survival =                                   55yrs*


Summary.  Cost QALY. Survival( life years)
MDI.            £0.189M. . 27.      45
Pump.         £0.188M.  33.       50
AI.                £0.199M.  44.       55
Table: summary

                            Incremental
                            Cost.  QALY. Life yrs
P vs M              £1000,      6,        5
£/QALY.          £167/ QALY
£/LY.               £200/LY

A vs M          £10000,     17,       10
£/QALY.            £588/QALY
£/LY.                £1000/LY

A vs P.           £11000,       11.        5
£/QALY.           £1000/QALY
£/LY.                £2200/LY

Outcome Difference Table
Key: M=MDI,  P= pump no sensor, A= AI

Interpretation

The lower the extra (incremental).cost/ QALY and cost/ Life year, the more cost-effective the new treatment ( left hand as opposed to right hand letters in the Outcome Difference Table) .

The above uses estimates of QALY and survival effects more than costs and accordingly is at best indicative, rather than a fair estimate.  Furthermore additional costs of t1d associated morbidity have not been added. 

 However as worse control would be expected with non-AI regulated management of t1d,  
non-AI treatment would have higher costs  eg from more patients requiring laser surgery, haemidialysis and the same patients suffering lower qol + survival than treatment by AI, which make a still stronger case for use of AI. Accordingly this would lessen the extra cost of AI vs ither treatments and increase the effect gains attribute to ai above other treatments.  Combined, inclusion of diabetes related morbidities would further increase the likelihood of ai funding if tge assumptions in the nominal estimate were met.  So i think there's hope, contingent on trial results and manufacturers' costs.


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## SB2015

grovesy said:


> Re your phone I usally buy my phones unlocked, and I have a SIM only contract.


I do the same @grovesy .
I am not into downloading loads of stuff, so it works out a lot cheaper just to buy the phone and then I get the cheapest package which gives me plenty of calls, texts and data.


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## everydayupsanddowns

Just seeing if i can look up data usage.

EDIT:
OK so... I last reset my mobile data stats mid September, so approx 2 weeks after I started on the TSlim.

Since then the main Dexcom App says it has used 291MB, and 'Dexcom Clarity' (graphs, stats and analysis) says it has used 25.1MB

So for Dex it looks like maybe 100MB a month?


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## SB2015

Paulbreen said:


> I’m just using them for the 7Days at the moment as they are a bit temperamental and I don’t have a problem with supply of them as my insurance pays for them, I’m a bit of a software guy so I’ll eventually take a closer look at them out of curiosity.
> look for a YouTube channel called Type one talks, the guy there can be a little hard to listen too but he is very much into sharing how to extend sensor life and stuff like that, I know he has his libre sensors working for a month now, I don’t recommend doing it but it can be done


Thanks Paul

I think I shall also  start just using the sensors as marketed, and then once things settle I will consider the option of restarting.


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## SB2015

everydayupsanddowns said:


> Just seeing if i can look it up


Thanks Mike

I am not particularly tech savvy  (as you know) and don’t want to make the mistake of getting one phone and then needing to update again.  I thought I had bought one that was okay last time, as the Medtronic people were saying it was fine so long as your phone was no more than 5 years old.  I think that they are very focused on iPhones so might end up going that way.

I have to have my new phone ready to link up for the pump start day, which  I have realised is so that they can check we have set up our pumps correctly before we go live with it.


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## daducky88

SB2015 said:


> I found out today, that the three of us being started on the 780 in a cou0ke of week’s time are the first ones in this area.  So the DSN is learning with us too, which is fine as he is happy to have the endless questions from us and we are all helping each other.


Good luck.  

It'd interesting to find out things like pump and cgm costs for the 780.


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## everydayupsanddowns

For Medtronic sensor on phone, I trialled the Guardian Connect (standalone CGM with no link to pump) on my old iPhone.

There's a screengrab of the then-compatibility warning on my blog post from the time








						Medtronic Guardian Connect Review - iPhone CGM in the cloud
					

Review of the new Medtronic Guardian Connect CGM which allows you to view sensor glucose on iPhone, and uploads to Carelink in the cloud.




					www.everydayupsanddowns.co.uk
				




Obviously that was a long time ago... And things have almost certainly changed by now.

I don't know if Guarduan Connect is what the future releases will use but this lists compatible devices and OS for that





						Blue Balloon Challenge | Medtronic Diabetes
					

Living with Type 1 diabetes is a constant balancing act. It´s like doing everything in your daily life, while keeping a balloon in the air




					guardianconnect.medtronic-diabetes.co.uk


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## daducky88

SB2015 said:


> So apart from the interesting suggestions of what else to spend my pension on, and comparisons between the costs of the system, ....
> 
> I urgently need to buy my new phone before my pump start training so can anyone answer these questions:
> 
> I never use a contract to buy my phones as I don’t use much data and  don’t do big downloads etc so the contracts mean I am paying for  a lot more than I need.  *How much data do I need to allow for the links to my phone*?  This is probably similar on any CGM system so any advice welcome (@everydayupsanddowns , @Stitch147 , @MrDaibetes ...)
> Am I right in thinking that my phone only needs to be compatible with the pump, the sensor won’t matter.  I don’t want to have to buy another phone if I change to the next sensors in the future.
> Also if I don’t have my phone with me all the time, does the phone gather up the data from that gap when the pump and phone get back together again?


Hi SB

I dobt know the answers but if your data is non-pictorial, ie just numbers, it should be quite small.. Plusnet do a shed of data for £8 inc calls and texts.


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## daducky88

daducky88 said:


> Good luck.
> 
> It'd interesting to find out things like pump and cgm costs for the 780.




How did you get nominated for the 780? Did you have an nhs funded sensor ( and pump) prior?


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## daducky88

Paulbreen said:


> I would say once the technology is proven, it’s early days, the powers than be will realise the benefits of closed loop treatment, I’m 85-95% in my target range since using the pump, the health benefit of that kind of result will save them millions on treating diabetic related illnesses


Thats very good and i bet your target is narrower than on mdi or pump no sensor


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## daducky88

daducky88 said:


> Hi SB
> 
> I dobt know the answers but if your data is non-pictorial, ie just numbers, it should be quite small.. Plusnet do a shed of data for £8 inc calls and texts.


And you can stop the contract without a tie in.


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## Paulbreen

daducky88 said:


> I hope you're right.
> However as future benefit e.g. morbidity avoided, survival extended is discounted due to preference for spending now, but the cost is incurred before as well as during the benefit period, this will put a higher demand on size of beneficial effect in addition to tge high on going costs of treatment with fancy kit.
> 
> As fag packet calc
> Eg for a 26 yr old living til 71 assuming 10 yrs reduction in life on average on mdi
> 
> *On multiple daily injections*
> Fixed Costs =£200
> (Pen injector x2 £100 = £200
> Glycaemia testor £0 )
> 
> *Recurrent Costs £ pa*
> Disposable needle tips pa £50
> Insulin detemir £42/1500U =365*20U/day*42/1500 =£204pa
> Insulin humalog £30/1500U = £146pa
> Blood test strips 6 / day +365*£15/50=£657pa
> Glucagon 4 pa +£11.52/mg = £46pa
> 2A+E visits pa. 2x250 =£500pa
> 1 o/n hospitalisatn pa £1600pa
> 
> Consultancy Fees
> Diabetic + opthamology 6 mnthly £1000pa
> estimate- i dont what these really cost
> 
> Total
> One off. £200
> Recurrent: £4203pa
> *Lifetime = £0.189M per patient
> Quality Adjusted Yrs =45* 0.60 = 27
> Survival = 45 yrs
> 
> ----
> pump.no sensor*
> 
> Fixed Costs =£3000
> (Pump £3000
> Glycaemia testor £0 )
> 
> *Recurrent Costs £ pa*
> Plastics
> Canula £9.80 each, 3 days dur=9.8×365/3=                        £1192pa
> Reservoirs £2.90 each, 3 says dur = 2.9x365/3=                                 £353pa
> 
> Insulin humalog 40U/ day £16/1000U =                                                           £234pa
> Blood test strips 6 / day +365*£15/50=                                                            £657pa
> Glucagon 2 pa +£11.52/mg = £23pa
> 2 paramed visits pa. 2x125 =£250pa
> est.
> 
> 
> Consultancy Fees
> Diabetic + opthamology 6 mnthly est.                                                             £1000pa
> 
> 
> Total
> One off. £3000
> Recurrent: £3709pa
> *Lifetime = £0.188M per patient
> Quality Adjusted Yrs =50* 0.66 = 33
> Survival = 50yrs
> 
> ---
> 
> AI System*
> 
> Fixed Costs =£5500
> (Pump £5500 est )
> 
> *Recurrent Costs £ pa*
> Plastics
> Canula £9.80 each, 3 days dur=9.8×365/3=                        £1192pa
> Reservoirs £2.90 each, 3 says dur = 2.9x365/3=                                 £353pa
> 
> Insulin humalog 40U/ day £16/1000U =                                                           £234pa
> Sensor                                                                                                                   £1200pa
> Glucagon 0.25 pa +£11.52/mg = £2.88pa
> 0.25 pa paramed visits pa. 0.25x125.                                                            =£31.25pa
> 
> 
> Consultancy Fees
> Diabetic + opthamology 12 mnthly est.                                                             £500pa
> Total
> One off. Est  £5500
> Recurrent: £3513pa
> *Lifetime = £0.199M per patient
> Quality Adjusted Yrs =55* 0.8 = 44
> Survival = 55yrs*
> 
> 
> Summary.  Cost QALY. Survival( life years)
> MDI.            £0.189M. . 27.      45
> Pump.         £0.188M.  33.       50
> AI.                £0.199M.  44.       55
> 
> 
> Incremental
> Cost.  QALY. Life yrs
> pump vs mdi.   £1000.  6.         5
> £/QALY.  £167/ QALY
> £/LY.       £200/LY
> ai vs mdi.       £10000. 17.       10
> £/QALY. £588/QALY
> £/LY.    £1000/LY
> ai vs pump.   £11000.  11.        5
> £/QALY.    £1000/QALY
> £/LY.           £2200/LY
> 
> Interpretation
> 
> The lower the extra (incremental).cost/ QALY and cost/ Life year, the more cost-effective the new treatment.
> The above uses estimates of effects more than cists and accordingly is at best indicative, rather than a fair estimate.  Furthermore additional costs of morbidity have not be added.  However as worse control would be expected with non-AI regulated management of t1d,  non-AI treatment would have higher costs eg from more patients than ai requiring laser surgery, haemidialysis and the same patients suffer these additional illnesses would have lower QALYs and LYs than treatment by AI, which make a still stronger case for use of AI.  So i think there's hope, contingent on trial results and manufacturers' costs.


I’m going have to sit and read all of that on my PC, it’s too much to take in on the phone lol but very interesting to see the budget costs laid out like that.
One thing to add to the calculation is the price the health services would pay compared to the market price, I’m pretty sure the equipment would be heavily discounted and even the drug companies loss leading the equipment just to sell their insulin’s.
The move towards closed loop systems has upset their world quite a lot where there is more or less monopolies controlling the insulin manufacturing and sales. 
interesting times are ahead and for once it maybe the sufferers that will benefit after years of stagnation


----------



## daducky88

SB2015 said:


> So apart from the interesting suggestions of what else to spend my pension on, and comparisons between the costs of the system, ....
> 
> I urgently need to buy my new phone before my pump start training so can anyone answer these questions:
> 
> I never use a contract to buy my phones as I don’t use much data and  don’t do big downloads etc so the contracts mean I am paying for  a lot more than I need.  *How much data do I need to allow for the links to my phone*?  This is probably similar on any CGM system so any advice welcome (@everydayupsanddowns , @Stitch147 , @MrDaibetes ...)
> Am I right in thinking that my phone only needs to be compatible with the pump, the sensor won’t matter.  I don’t want to have to buy another phone if I change to the next sensors in the future.
> Also if I don’t have my phone with me all the time, does the phone gather up the data from that gap when the pump and phone get back together again?


A good point


----------



## daducky88

Paulbreen said:


> I’m going have to sit and read all of that on my PC, it’s too much to take in on the phone lol but very interesting to see the budget costs laid out like that.
> One thing to add to the calculation is the price the health services would pay compared to the market price, I’m pretty sure the equipment would be heavily discounted and even the drug companies loss leading the equipment just to sell their insulin’s.
> The move towards closed loop systems has upset their world quite a lot where there is more or less monopolies controlling the insulin manufacturing and sales.
> interesting times are ahead and for once it maybe the sufferers that will benefit after years of stagnation


I pulled the costs from the BNF, brit natnl formulary whuch dont very too much between list and nhs costs.  I suspect pump and injections might be given free ro tge ngs as inducements, similar to test kits as the longer consumable cost more than covers such a cost.


----------



## daducky88

daducky88 said:


> I pulled the costs from the BNF, brit natnl formulary whuch dont very too much between list and nhs costs.  I suspect pump and injections might be given free ro tge ngs as inducements, similar to test kits as the longer consumable cost more than covers such a cost.


Similar to nhs mortgages on hospitals.
The gov borrows off itself for a drama via QE^n, but pays 40% of a hospitals annual cost on the mortgage...ergo payas your is in preference to up front costs.


----------



## daducky88

Paulbreen said:


> I’m going have to sit and read all of that on my PC, it’s too much to take in on the phone lol but very interesting to see the budget costs laid out like that.
> One thing to add to the calculation is the price the health services would pay compared to the market price, I’m pretty sure the equipment would be heavily discounted and even the drug companies loss leading the equipment just to sell their insulin’s.
> The move towards closed loop systems has upset their world quite a lot where there is more or less monopolies controlling the insulin manufacturing and sales.
> interesting times are ahead and for once it maybe the sufferers that will benefit after years of stagnation




Unfortunately banandroid err "rearranged" the nice formulating of my tables, the beast whuch doesnt help :-/


----------



## Paulbreen

daducky88 said:


> Thats very good and i bet your target is narrower than on mdi or pump no sensor


I have 4.8 - 5.5 as my target, I get a bit obsessed with it lol, when I was doing the training for the pump I was in a hospital clinic for 6 days so I could be monitored, as we were setting up the basal settings, finger pricking every 2 hours day and night was a pain but it makes you very aware of your BG and the effects of your diet, I would get flustered when my BG would go up to 9.0 or 10.0 after eating but the doctor told me not worry about those peaks as long as they were flattening out and coming back to range as the bolus insulin kicked in


----------



## daducky88

Paulbreen said:


> On the whole thes sensors are ok but not fantastic, I use their guardian 3 sensor and they have been known to fail now and then I would say don’t expect a Libre style sensor, fit and forget.
> if they dislodge at all you can expect a lot of wasted time waiting for them to calibrate only for your pump to tell you to change it after 5 hours. For some reason during the day they are great but during the night everything seems to happen, kicked out of auto mode because of wanting a BG when it was calibrated 4 hours ago is one that seems to plague me at the moment.
> I heard a new one is on the horizon that deals with the issues people are reporting but we will have to see what hurdles the FDA put up for it to become reality


Really there should be a block wide interoperability.standard to permit selection on price quality interface.


----------



## daducky88

Paulbreen said:


> I have 4.8 - 5.5 as my target, I get a bit obsessed with it lol, when I was doing the training for the pump I was in a hospital clinic for 6 days so I could be monitored, as we were setting up the basal settings, finger pricking every 2 hours day and night was a pain but it makes you very aware of your BG and the effects of your diet, I would get flustered when my BG would go up to 9.0 or 10.0 after eating but the doctor told me not worry about those peaks as long as they were flattening out and coming back to range as the bolus insulin kicked in


What was your range before you were on a pump and sensor? 

And if you imagine a thermometer with 
100%  quality of life, (qol) across work, social, personal, exercise and leisure
65% as chronic disease which interferes with normal life patterns eg haemodialysis (3x/wk 4 hr dialysis)
 0 as death, 
-0.3 as screaming pain worse than death 

How woyld you rate your qol now and before you started your current form of t1d management.?

I appreciate. feelings about qol will vary over time, but even so, an indication is useful.


----------



## daducky88

Mine on pump no sensor is 
mM
6.4 +/- 0.5mM 7am-9pm
7.4 +/- 0.5mM 9pm-7am

I say im in range 30% of time.

I cant lower the day target without hypoing frequently and loosing  awareness.  


Paulbreen said:


> I have 4.8 - 5.5 as my target, I get a bit obsessed with it lol, when I was doing the training for the pump I was in a hospital clinic for 6 days so I could be monitored, as we were setting up the basal settings, finger pricking every 2 hours day and night was a pain but it makes you very aware of your BG and the effects of your diet, I would get flustered when my BG would go up to 9.0 or 10.0 after eating but the doctor told me not worry about those peaks as long as they were flattening out and coming back to range as the bolus insulin kicked i


----------



## Paulbreen

daducky88 said:


> What was your range before you were on a pump and sensor?
> 
> And if you imagine a thermometer with
> 100%  quality of life, (qol) across work, social, personal, exercise and leisure
> 65% as chronic disease which interferes with normal life patterns eg haemodialysis (3x/wk 4 hr dialysis)
> 0 as death,
> -0.3 as screaming pain worse than death
> 
> How woyld you rate your qol now and before you started your current form of t1d management.?
> 
> I appreciate. feelings about qol will vary over time, but even so, an indication is useful.


I remember starting with the Libre sensors and was amazed to manage 65% with my target range at 4.5 - 8.5. The pump definitely has made a massive difference to my life. 
i don’t really have Hypos or Hypers any more when everything is running well.
I’m not so tired anymore and I don’t have to fight my illness to live my life how I would like too


----------



## SB2015

everydayupsanddowns said:


> For Medtronic sensor on phone, I trialled the Guardian Connect (standalone CGM with no link to pump) on my old iPhone.
> 
> There's a screengrab of the then-compatibility warning on my blog post from the time
> 
> 
> 
> 
> 
> 
> 
> 
> Medtronic Guardian Connect Review - iPhone CGM in the cloud
> 
> 
> Review of the new Medtronic Guardian Connect CGM which allows you to view sensor glucose on iPhone, and uploads to Carelink in the cloud.
> 
> 
> 
> 
> www.everydayupsanddowns.co.uk
> 
> 
> 
> 
> 
> Obviously that was a long time ago... And things have almost certainly changed by now.
> 
> I don't know if Guarduan Connect is what the future releases will use but this lists compatible devices and OS for that
> 
> 
> 
> 
> 
> Blue Balloon Challenge | Medtronic Diabetes
> 
> 
> Living with Type 1 diabetes is a constant balancing act. It´s like doing everything in your daily life, while keeping a balloon in the air
> 
> 
> 
> 
> guardianconnect.medtronic-diabetes.co.uk


Thanks Mike

I have their up to date list of compatible phones for their equivalent system, now called Carelink.
Your data bout the amount of data you have used is a good indicator, and my current contract of £5/month includes 3GB of data, so I don’t think I need to worry about whether I will have enough.

All I need is to chose a phone off their list and I think I should be sorted.  I will also do my usual practice of paying for them to do all the setting up for me (Before I get lots of messages telling me it easy I have tried it once, and personally leaving them my phone for an hour , giong or stroll and coming back seems worth every penny)

Thanks again


----------



## Paulbreen

daducky88 said:


> Mine on pump no sensor is
> mM
> 6.4 +/- 0.5mM 7am-9pm
> 7.4 +/- 0.5mM 9pm-7am
> 
> I say im in range 30% of time.
> 
> I cant lower the day target without hypoing frequently and loosing  awareness.


I am of the opinion there is a sweet spot where your body likes to be and it’s different for everyone. The medical world have to work within their wider range but only you know what feels good for you, looking at those parameters your keeping yourself very tight, you might listen to your body as well when your deciding where to define what’s good for you.


----------



## SB2015

The 780 now offers a choice of targets to use when in sensors.  The previous one had 6.7 as its lowest I think, but I work to 5.5 on my current pump.  I set a single figure target to get corrections with each Bolus (apart from the rare occasion I am spot on). It was this option of reducing the target to seomthig closer to my preference helped to push me towards this pump.

On my current pump, using the Libre sensor, I usually average 80% time in range.  This has been achieved through swiping the sensor lots and using many corrections, as well as using the info from the Libre to help me find an appropriate time interval for my pre-blouses at each meal.

I doubt I will get much better TIR but I am wanting the pump to reduce the amount of my time is used up by my Diabetes.  I shall see what happens.


----------



## daducky88

SB2015 said:


> Thanks Mike
> 
> I am not particularly tech savvy  (as you know) and don’t want to make the mistake of getting one phone and then needing to update again.  I thought I had bought one that was okay last time, as the Medtronic people were saying it was fine so long as your phone was no more than 5 years old.  I think that they are very focused on iPhones so might end up going that way.
> 
> I have to have my new phone ready to link up for the pump start day, which  I have realised is so that they can check we have set up our pumps correctly before we go live with it.


It could be worth t'phoning medtronic and asking them when they are gonna release an android version as new Apples are very expensive.


----------



## Paulbreen

My 670 allows you down to 3.3 but up to what you like to have, it will let you know if you setup parameters outside the norm but will allow you to do it anyway


----------



## daducky88

Paulbreen said:


> I am of the opinion there is a sweet spot where your body likes to be and it’s different for everyone. The medical world have to work within their wider range but only you know what feels good for you, looking at those parameters your keeping yourself very tight, you might listen to your body as well when your deciding where to define what’s good for you.



For me, its a limitation in:
* my ability to predict across multiple interacting variables across a partial data isnt helped by a lack of sensor
* decreasing risk appetite

Sweet spots i think can be / are trained.  I used function sort of at 2.3mM and 4mM felt fine.


----------



## Paulbreen

daducky88 said:


> For me, its a limitation in:
> * my ability to predict across multiple interacting variables across a partial data isnt helped by a lack of sensor
> * decreasing risk appetite
> 
> Sweet spots i think can be / are trained.  I used function sort of at 2.3mM and 4mM felt fine.


Wow that’s low, my magic number is 3.8 and has been for years so I suppose I’m pretty lucky


----------



## Paulbreen

daducky88 said:


> It could be worth t'phoning medtronic and asking them when they are gonna release an android version as new Apples are very expensive.


I checked in the link I shared with you earlier and it says their minimed app is available in IOS and Android so you should be ok, wouldn’t do any harm to check tho


----------



## daducky88

Paulbreen said:


> I remember starting with the Libre sensors and was amazed to manage 65% with my target range at 4.5 - 8.5. The pump definitely has made a massive difference to my life.
> i don’t really have Hypos or Hypers any more when everything is running well.
> I’m not so tired anymore and I don’t have to fight my illness to live my life how I would like too


So would you estimate you feel now

100% aok

And before

70%?


Paulbreen said:


> Wow that’s low, my magic number is 3.8 and has been for years so I suppose I’m pretty lucky



 Threeee is the magic nuuumber...

Well i-ve also sort of functioned at 1.3mM.


----------



## SB2015

daducky88 said:


> How did you get nominated for the 780? Did you have an nhs funded sensor ( and pump) prior?


I have had a pump on NHS for eight years now
I initially self funded the Libre sensors and then got them on NHS.
I have never had CGM funded.

For my next pump I was offered the 780 In the understanding that I would have  to self fund the sensors to use it with CGM.  Without sensors it behaves like a 640


----------



## Paulbreen

When I started the 670 Training I spent 2 weeks in the manual mode and that wasn’t that bad compared to having a bolus and a basal insulin, bolus is pretty easy to get more or less right but in 20 years I never got the basal working properly.
So even without the CGM working in auto mode just having the basal template being controlled by the pump is a game changer. @SB2015 i think you will have a ball when you go full auto with the CGM


----------



## Paulbreen

daducky88 said:


> So would you estimate you feel now
> 
> 100% aok
> 
> And before
> 
> 70%?
> 
> 
> Threeee is the magic nuuumber...
> 
> 
> iWell i-ve also sort of functioned at 1.3mM.


I would say I’m a good 90% these days, I don’t really remember how bad I felt before the pump anymore but some days were a real struggle


----------



## daducky88

Paulbreen said:


> I would say I’m a good 90% these days, I don’t really remember how bad I felt before the pump anymore but some days were a real struggle


So here a revision to my prior estimate:

CEA of MDI, PUMP & AI - nominal figures, back of a fag packet


Costs £,2020MDiPump no SensorAI closed loopFixed costsPen injector
2x£100 =20035403540Recurrent Costs
 £ paNeedles50nanaInsulin long acting
Determir £42/1500U
20U day204nanaInsulin short
acting
Humalog(£28/1000, 3ml vial, 20u/day)
146£16/1000, 10ml vial, 40U/day)
234£16/1000, 10ml vial, 40U/day)
234Canulana(3 days duration £9.80 each)

11921830Reservoir(£2.90each, 3 days dur)

353(Part of 1830)CGMnana2685Test strips £15/50,
6/day657657naGlucagon
£11.52 each(4 pa)
46(2 pa)
23(0.25 pa)

2.88Visits £250est/ visit(2 visits A&E pa, est)
500(2 *£125 paramed visits)

250(0.25 *£125 paramed visits pa)

31.25O’n hospitalisatn £1600/pn(1/pa)
1600(0 est)(0 est)Consultancy fees
£250 per visit est
Diabetes &opthamology(2*2 xpa, est)
1000 est(2*2 xpa, est)
1000 est(1 of each pa est)
500 estOne Off £20035403540Recurrent £ pa420337085293Life Years est455055Lifetime cost0.1891M0.1889M0.294MQALYs pa0.740.740.9Lifetime QALYs from diagnosis to death33.33749.5
Table 1: Cost and Effect Inputs ~indicative

Analysis


Lifetime incremental Costincremental
QALYincremental
Yrs(Possible) DecisionPump vs MDI-£2003.75Pump dominates MDIPump dominates MDIUse pump over MDIAI vs MDI£10400016.210Incr £/QALY ratio
£6420/QALYIncr £/LY ratio
£10400/LYNominal values would support use of AI over MDIAI vs Pump£10510012.55Incr £/QALY ratio
£8408/QALYIncr £/LY ratio
£21020/LYNominal values support use of AI rather than pump no sensor re QALY but not re clinical outcomes incremental LY ratio due to the lower nominally expected LY gain of AI over a pump(5 yr increment) vs AI over MDI(10 yr increment.
Additional data may better support use of AI including for comorbidities of T1D.

Table 2: Analysis Incremental Cost, QALYs and Survival

Utility information
where QALYs= utilty x time
Baseline (MDI) quality of life in UK: 0.75; https://hqlo.biomedcentral.com/articles/10.1186/s12955-015-0396-0
De Souza et al 2015. Health-related quality of life in people with type 1 Diabetes Mellitus: data from the Brazilian Type 1 Diabetes Study Group
Quality of Life Pump:0.75; various reports indicate no sig diff between pump & MDI
Eg https://academic.oup.com/jpepsy/article/31/6/650/899719, which reports HRQOL generic 0.79 and HRQOL disease spec 0.69, 0.74 was used a mean value, noting these values found in children in the US so UK adults may differ
Quality AI: 0.9; ltd info availability, AI user input used, sample of 1…

Costs were drawn from published data (BNF) where possible or otherwise estimated e.g. hospital visit fees. Quality of life was taken from publications, noting values for pump use were derived from a study on children in the US so may not be representative of UK adult values.  AI qol is from a subject matter expert, an AI system user.  Survival data are purely estimated based on nominal assumption. This would need checking against published data.


Interpretation
With the incremental cost effectiveness ratios (ICERs), see table, the lower values in the table, the more cost effective the item is either by producing more effect and or lower costs than to whats its compared. For example at the bottom of table, lifetime cost for pumps is expected to marginally lower than for MDI giving a better ie lower ICER ratio that is, if the value in this estimate represented real life, pumps would be more cost- and clinically effective than MDI.

But what of AI systems,  such as but necessarily ltd to T1slim or Minimed 670,  to MDI?  The ICER for AI vs MDI is £6420/QALY, so not as cost-effective as the pump.  Furthermore ai has a yet worse cost-effectiveness ratio at £8408/QALY for AI vs pump without sensor technology.
However these estimate are based on crude assumptions or nominal rather than real values, so real data may tell a diff story.

Clinical outcomes showed more variation.  Estimated incremental cost/ life year were better value ie lower for the  pump than MDI(ai use was predicted to be associated with lower cost, more life years) i.e. the pump dominated MDI, then AI vs MDI £10400/ extra year, than AI vs pump £21020/ extra year of life.  The higher ie worse AI vs pump clinical effectiveness ratio is a product of an estimated smaller additional length of life of ai over a pump user (5 yrs) vs ai over MDI users (10 yrs).  These estimates are purely nominal and real world data may vary.  However user input on quality of life shows a marked improvement of ai over publ QALYs for pump no sensor or mdi.  For a chronic disease, a lifetime average improved quality lends weight to the use of such a technology as ai, as indeed the incremental cost-effectiveness ratio estimate indicates.

Long term t1D morbidities’ effects and costs e.g. from haemodialysis, sight loss etc  have not been included here.  However as worse control would be expected with non-closed loop AI regulated management of t1d e.g. the pump no sensor or pump open loop and MDI, non-AI treatment would have higher ie worse incremental cost and clinical effectiveness ratios, supporting the use of closed loop AI systems if they indeed prove to provide high quality of life to patients and longer survival without excessive extra cost.   Time will tell.

So there may be some hope perhaps depending on the figures from real studies and trials.  More data will help clarify the score.


----------



## Paulbreen

daducky88 said:


> So here a revision to my prior estimate:
> 
> CEA of MDI, PUMP & AI - nominal figures, back of a fag packet
> 
> 
> Costs £,2020MDiPump no SensorAI closed loopFixed costsPen injector
> 2x£100 =20035403540Recurrent Costs £ paNeedles50nanaInsulin long acting
> Determir £42/1500U
> 20U day204nanaInsulin short acting
> Humalog£42/1500U(£28/1000, 3ml vial, 20u/day)
> 146£16/1000, 10ml vial, 40U/day)
> 234£16/1000, 10ml vial, 40U/day)
> 234Canulana(3 days duration £9.80 each)
> 
> 11921830Reservoir(£2.90each, 3 days dur)
> 
> 353(Part of 1830)CGMnana2685Test strips £15/50,
> 6/day657657naGlucagon
> £11.52 each(4 pa)
> 46(2 pa)
> 23(0.25 pa)
> 
> 2.88Visits £250est/ visit(2 visits A&E pa, est)
> 500(2 *£125 paramed visits)
> 
> 250(0.25 *£125 paramed visits pa)
> 
> 31.25O’n hospitalisation £1600/pn(1/pa)
> 1600(0 est)(0 est)Consultancy fees
> £250 per visit est
> Diabetes &opthamology(2*2 xpa, est)
> 1000 est(2*2 xpa, est)
> 1000 est(1 of each pa est)
> 500 estOne Off £20035403540Recurrent £ pa420337085293Life Years est455055Lifetime cost0.1891M0.1889M0.294MQALYs pa0.740.740.9Lifetime QALYs from diagnosis to death33.33749.5
> Table 1: Cost and Effect Inputs ~indicative
> 
> Analysis
> 
> 
> Lifetime IncrementCostQALYYrs(Possible) DecisionPump vs MDI-£2003.75Pump dominates MDIPump dominates MDIUse pump over MDIAI vs MDI£10400016.210Incr £/QALY ratio
> £6420/QALYIncr £/LY ratio
> £10400/LYNominal values would support use of AI over MDIAI vs Pump£10510012.55Incr £/QALY ratio
> £8408/QALYIncr £/LY ratio
> £21020/LYNominal values support use of AI rather than pump no sensor re QALY but not re clinical outcomes incremental LY ratio due to the lower nominally expected LY gain of AI over a pump(5 yr increment) vs AI over MDI(10 yr increment.
> Additional data may better support use of AI including for comorbidities of T1D.
> 
> Table 2: Analysis Incremental Cost, QALYs and Survival
> 
> Utility information
> Baseline (MDI) quality of life in UK: 0.75; https://hqlo.biomedcentral.com/articles/10.1186/s12955-015-0396-0
> De Souza et al 2015. Health-related quality of life in people with type 1 Diabetes Mellitus: data from the Brazilian Type 1 Diabetes Study Group
> Quality of Life Pump:0.75; various reports indicate no sig diff between pump & MDI
> Eg https://academic.oup.com/jpepsy/article/31/6/650/899719, which reports HRQOL generic 0.79 and HRQOL disease spec 0.69, 0.74 was used a median value, noting these values found in children in the US so UK adults may differ
> Quality AI: 0.9; ltd info availability, AI user input used, sample of 1…
> 
> Costs were drawn from published data (BNF) where possible or otherwise estimated e.g. hospital visit fees. Quality of life was taken from publications, noting values for pump use were derived from a study on children in the US so may not be representative of UK adult values.  AI qol is from a subject matter expert, an AI system user.  Survival data are purely estimated based on nominal assumption. This would need checking against published data.
> 
> 
> Interpretation
> With the incremental cost effectiveness ratios (ICERs), see table, the lower values in the table, the more cost effective the item is either by producing more effect than whats its compared to and/ or by having lower costs than compared to.  For example at the bottom of table, lifetime cost for pumps is expected to marginally lower than for MDI giving a better ie lower ICER ratio that is, if the value in this estimate represented real life, pumps would be more cost- and clinically effective than MDI.
> 
> But what of AI systems,  such as but necessarily ltd to T1slim or Minimed 670,  to MDI?  The ICER for AI vs MDI is £6420/QALY, so not as cost-effective as the pump.  Furthermore ai has a yet wrose cost-effectiveness ratio at £8408/QALY for AI vs pump without sensor technology.
> However these estimate are based on crude assumptions or nominal rather than real values, so real data may tell a diff story.
> 
> Clinical outcomes showed more variation.  Estimated incremental cost/ life year were better value ie lower for the  pump than MDI(ai use was predicted to be associated with lower cost, more life years) i.e. the pump dominated MDI, then AI vs MDI £10400/ extra year, than AI vs pump £21020/ extra year of life.  The higher ie worse AI vs pump clinical effectiveness ratio is a product of an estimated smaller additional length of life of ai over a pump user (5 yrs) vs ai over MDI users (10 yrs).  These estimates are purely nominal and real world data may better or worse support the use of ai.  However user input ion quality of life shows a marked improvement of ai over pump no sensor or mdi.  For a chronic disease, a lifetime of improved quality lends weight to the use of such a technology as ai, as indeed the incremental cost-effectiveness ratio estimate indicates.
> 
> Long term t1D morbidities’ effects and costs e.g. from haemodialysis, sight loss etc  have not been included here.  However as worse control would be expected with non-closed loop AI regulated management of t1d e.g. the pump no sensor or pump open loop and MDI, non-AI treatment would have higher ie worse incremental cost and clinical effectiveness ratios, supporting the use of closed loop AI systems if they indeed prove to provide high quality of life to patients and longer survival without excessive extra cost.   Time will tell.
> 
> So there may be some hope perhaps depending on the figures from real studies and trials.  More data will help clarify the score.


Well I’m pretty impressed with that analysis, you have too much time on your hands and you should be full time lobbying the powers that be to asses all T1’s and T2’s where applicable for full CGM closed loop systems especially for the young where the long term benefits would be significant


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## everydayupsanddowns

Interesting work @daducky88    

When I was a lay member on the Guideline Development Group for CG15 (which published in 2015) there was a novel cost effectiveness analysis for QALYs and ICERs between CGM and various intensities of SMBG (which have may have been part of the evidence that underpinned the ‘8 strips a day’ Libre limit?)

At the time the clinical evidence of effectiveness for CGM was not as compelling as I believe it has become since, and I very much suspect that CGM and hybrid closed loop will be getting a thorough looking at as they are updating the T1 guidance again at the moment





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						Overview | Type 1 diabetes in adults: diagnosis and management  | Guidance | NICE
					






					www.nice.org.uk


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## daducky88

Well i'm on the hunt for a job at the min or to use the euphemism, between contracts.
And in between times trying teach myself some skills in writing algorithms.


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## daducky88

But my table is really a quick and dirty indication, more a process chart. There's a loft hefty work required to statistically meaningfully search, clean, combine, extrapolate trials' data to get a representative set of figures for the UK diab pop.   I imagine most of the relevant manufs have ongoing followups in trials progressing and nice is in discussion with review teams.


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## daducky88

daducky88 said:


> Well i'm on the hunt for a job at the min or to use the euphemism, between contracts.
> And in between times trying teach myself some skills in writing algorithms though i'm not a mathematician, unfortunately.
> 
> I had to leave my old career of immunology and my ambition to derive a vaccine against t1d for which i made some tentative progress thru jobs in dff labs across Europe.  Unlike other labs at the time chasing their favourite candidate antigen or using animal models with liberal activatiin requirements leading to a high false positive rate and an equal oublication rate, my work on only more tightly immune regulated human T cells showed the pleitropism of receptor specificity eg receptors can recognise up to 30 structurally different ligands, and dealt with receptor screening on a 10^15 scale rather than the 10^6 libraries most places were then using.  Later i headed a lab to develop a new class of  tolerisation vaccine ie change imm resp from Th1 to Th2.  But undiagnosed addisons gave me a hypo a night for half a year and borderline hypo the rest of the time with very poor medical support despite numerous visits to hospitals.  I decided to go home.  My then wife insisted i go to hospital where King's College London diagnosed me


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## daducky88

daducky88 said:


> Well i'm on the hunt for a job at the min or to use the euphemism, between contracts.
> And in between times trying teach myself some skills in writing algorithms though i'm not a mathematician, unfortunately.
> 
> I had to leave my old career of immunology and my ambition to derive a vaccine against t1d for which i made some tentative progress thru jobs in dff labs across Europe.  Unlike other labs at the time chasing their favourite candidate antigen, my work showed the pleitropism of receptor specificity eg receptors can recognise up to 30 structurally different ligands, and dealt with receptor screening on a 10^15 scale rather than the 10^6 libraries most places were then using.  Later i headed a lab to develop a new class of  tolerisation vaccine ie change imm resp from Th1 to Th2.  But undiagnosed addisons gave me a hypo a night for half a year and borderline hypo the rest of the time with very poor medical support despite numerous visits to hospitals.  I decided to go home.  My then wife insisted i go to hospital where King's College London diagnosed me
> 
> 
> everydayupsanddowns said:
> 
> 
> 
> Interesting work @daducky88
> 
> When I was a lay member on the Guideline Development Group for CG15 (which published in 2015) there was a novel cost effectiveness analysis for QALYs and ICERs between CGM and various intensities of SMBG (which have may have been part of the evidence that underpinned the ‘8 strips a day’ Libre limit?)
> 
> At the time the clinical evidence of effectiveness for CGM was not as compelling as I believe it has become since, and I very much suspect that CGM and hybrid closed loop will be getting a thorough looking at as they are updating the T1 guidance again at the moment
> 
> 
> 
> 
> 
> __
> 
> 
> 
> 
> 
> Overview | Type 1 diabetes in adults: diagnosis and management  | Guidance | NICE
> 
> 
> 
> 
> 
> 
> 
> www.nice.org.uk
> 
> 
> 
> 
> 
> 
> 
> 
> 
> 
> everydayupsanddowns said:
> 
> 
> 
> Interesting work @daducky88
> 
> When I was a lay member on the Guideline Development Group for CG15 (which published in 2015) there was a novel cost effectiveness analysis for QALYs and ICERs between CGM and various intensities of SMBG (which have may have been part of the evidence that underpinned the ‘8 strips a day’ Libre limit?)
> 
> At the time the clinical evidence of effectiveness for CGM was not as compelling as I believe it has become since, and I very much suspect that CGM and hybrid closed loop will be getting a thorough looking at as they are updating the T1 guidance again at the moment
> 
> 
> 
> 
> 
> __
> 
> 
> 
> 
> 
> Overview | Type 1 diabetes in adults: diagnosis and management  | Guidance | NICE
> 
> 
> 
> 
> 
> 
> 
> www.nice.org.uk
> 
> 
> 
> 
> 
> Click to expand...
Click to expand...


That must have been interesting Mike. How did you get selected ?  

I supoose there's an unresolved of question whats a fair or adequate comparator in these sort of trials, complicated by Gov rationing by severity to limit expenditure,  a systematic bias against raising the quality of life of the maximum.number of people in place of lifting by a greater amount a small n of people.  Accordingly cherrying picking controls may not be representative of the f of diff management approaches for T1D in England.  I imagine in numbers, by NHS funding:
 mdi> pump no sensor> pump +sensor >ai


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## everydayupsanddowns

daducky88 said:


> That must have been interesting Mike. How did you get selected ?



It was! Very. There were 2 ‘lay” members of the group, and everyone was given an equal voice.

I think someone on a forum mentioned it. 

The NICE website has sections for guideline in development, and also publishes guidelines which are being planned. NICE has a thorough PPI (patient and public involvement) initiative, which publishes opportunities to get involved.

Then you need to put in an application and see whether you seem to fit the project


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## daducky88

Paulbreen said:


> Well I’m pretty impressed with that analysis, you have too much time on your hands and you should be full time lobbying the powers that be to asses all T1’s and T2’s where applicable for full CGM closed loop systems especially for the young where the long term benefits would be significant


Cheers Paul, thats my profession


Paulbreen said:


> Well I’m pretty impressed with that analysis, you have too much time on your hands and you should be full time lobbying the powers that be to asses all T1’s and T2’s where applicable for full CGM closed loop systems especially for the young where the long term benefits would be significant


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