Costs and Sustainability

T1DE services are described as low-volume, high-cost, and high-risk. Per-patient costs varied substantially across services, ranging from about £8,150 to £17,100. Costs are expected to fall and become more similar as services become embedded and treat more patients. Future economic evaluation should include hospital use, diabetic ketoacidosis admissions, emergency attendances, outpatient use, and wider healthcare outcomes. Trusts and Integrated Care Boards may struggle to fund T1DE services as routine care because the services are specialised, expensive per patient, and serve a small high-risk group. Short funding windows may be too brief to recruit staff, build trust, treat high-risk patients gradually, and collect long-term evidence.