{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:16:27Z","timestamp":1782450987998,"version":"3.54.5"},"reference-count":32,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Technology &amp; Therapeutics"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Immune therapies such as teplizumab and antithymocyte globulin (ATG) offer promise in delaying type 1 diabetes (T1D). However, growing availability of automated insulin delivery (AID) systems for insulin management may alter the cost-effectiveness of these therapies. Immune therapies may become more cost-effective when paired with AID instead of conventional insulin management. Meanwhile, as immune therapies delay T1D for only a short period, effective AID may reduce the economic value of prevention. This study provides the first cost-effectiveness analysis of the interplay between immune therapies and AID systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Using microsimulation modeling, we examined the cost-effectiveness of six alternative prevention-treatment strategies defined by a combination of three preventive immune therapies (teplizumab, ATG, or no therapy) and two insulin management strategies (AID or conventional insulin management). Effectiveness was measured by quality-adjusted life years (QALYs). Costs were estimated from a payer perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among the six strategies considered, preventive ATG therapy followed by AID was the most cost-effective. It entailed $394,250 in lifetime costs and yielded 19.13 QALYs. These costs were lower and QALY gains higher than those with strategies that did not involve immune therapy or AID. Preventive teplizumab therapy followed by AID generated 0.25 more QALYs than ATG therapy followed by AID, albeit at an additional cost of $153,670, resulting in an incremental cost-effectiveness ratio of $369,890\/QALY.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Preventive ATG therapy followed by AID after T1D onset can be a potentially cost-effective approach. In the absence of randomized clinical trials for ATG in the prevention space, findings in this study assume that ATG is at least half as efficacious as teplizumab. The optimal prevention-treatment strategy will ultimately depend on payers\u2019 ability to negotiate prices for teplizumab and further evidence on efficacy of ATG in preventing T1D.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/dia.2025.0192","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T12:28:39Z","timestamp":1747052919000},"page":"812-819","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["An Exploratory Cost-Effectiveness Analysis of Immune Therapy in Delaying the Initiation of Automated Insulin Delivery Systems in Type 1 Diabetes"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-2440-4313","authenticated-orcid":false,"given":"Shweta","family":"Mital","sequence":"first","affiliation":[{"name":"College of Pharmacy, University of Manitoba, Winnipeg, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2803-1824","authenticated-orcid":false,"given":"Michael J.","family":"Haller","sequence":"additional","affiliation":[{"name":"College of Medicine, Department of Pediatrics, University of Florida, Gainesville, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desmond A.","family":"Schatz","sequence":"additional","affiliation":[{"name":"College of Medicine, Department of Pediatrics, University of Florida, Gainesville, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai V.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Memorial University of Newfoundland, St. John\u2019s, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"e_1_3_5_2_2","unstructured":"Centers for Disease Control and Prevention. 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US Life Tables. 2022. Available from: https:\/\/www.cdc.gov\/nchs\/products\/life_tables.htm [Last accessed: January17 2025]."},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2017.06.007"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.12195"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e318216592c"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc17-1821"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.25.12.2238"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1405158"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.7326\/M20-1392"},{"key":"e_1_3_5_29_2","unstructured":"US Bureau of Labor Statistics. Median usual weekly earnings of full-time wage and salary workers by sex. 2020. 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