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Cost-effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections of insulin in Type 1 diabetes: a systematic review.
Diabet Med. 2015 Nov; 32(11):1415-24.DM

Abstract

AIM

Continuous subcutaneous insulin infusion (CSII) is increasingly used in clinical practice for the management of selected patients with Type 1 diabetes. Several cost-effectiveness studies comparing CSII vs. multiple insulin injections (MDI) have been reported. The aim was systematically to review these analyses and test the hypothesis that CSII is a cost-effective use of healthcare resources across settings.

METHODS

A literature review was performed using MEDLINE, Cochrane Library and other databases. No time limit or language restrictions were applied. After two rounds of screening, 11 cost-effectiveness analyses were included in the final review, of which nine used the CORE Diabetes Model. A narrative synthesis was conducted and mean cost effectiveness calculated.

RESULTS

CSII was considered cost-effective vs. MDI in Type 1 diabetes in all 11 studies in 8 countries, with a mean (95% CI) incremental cost effectiveness ratio of €30 862 (17 997-43 727), US$40 143 (23 409-56 876) per quality-adjusted life year (QALY) gained. CSII was associated with improved life expectancy and quality-adjusted life expectancy (0.4-1.1 QALYs in adults), driven by lower HbA(1c) and lower frequency of hypoglycaemic events vs. MDI. CSII was associated with higher lifetime direct costs due to higher treatment costs but this was partially offset by cost-savings from reduced diabetes-related complications.

CONCLUSIONS

Published cost-effectiveness analyses show that in Type 1 diabetes CSII is cost-effective vs. MDI across a number of settings for patients who have poor glycaemic control and/or problematic hypoglycaemia on MDI, with cost-effectiveness highly sensitive to the reduction in HbA1c and hypoglycaemia frequency associated with CSII.

Authors+Show Affiliations

HEVA HEOR, Lyon, France.Ossian Health Economics and Communications, Basel, Switzerland.Ossian Health Economics and Communications, Basel, Switzerland.Medtronic International Sàrl, Tolochenaz, Switzerland.Department of Endocrinology, Hvidovre University Hospital, Hvidovre, Denmark.Diabetes Research Group, King's College London School of Medicine, Guy's Hospital, London, UK.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

25962621

Citation

Roze, S, et al. "Cost-effectiveness of Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections of Insulin in Type 1 Diabetes: a Systematic Review." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 32, no. 11, 2015, pp. 1415-24.
Roze S, Smith-Palmer J, Valentine W, et al. Cost-effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections of insulin in Type 1 diabetes: a systematic review. Diabet Med. 2015;32(11):1415-24.
Roze, S., Smith-Palmer, J., Valentine, W., de Portu, S., Nørgaard, K., & Pickup, J. C. (2015). Cost-effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections of insulin in Type 1 diabetes: a systematic review. Diabetic Medicine : a Journal of the British Diabetic Association, 32(11), 1415-24. https://doi.org/10.1111/dme.12792
Roze S, et al. Cost-effectiveness of Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections of Insulin in Type 1 Diabetes: a Systematic Review. Diabet Med. 2015;32(11):1415-24. PubMed PMID: 25962621.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections of insulin in Type 1 diabetes: a systematic review. AU - Roze,S, AU - Smith-Palmer,J, AU - Valentine,W, AU - de Portu,S, AU - Nørgaard,K, AU - Pickup,J C, Y1 - 2015/05/28/ PY - 2015/05/07/accepted PY - 2015/5/13/entrez PY - 2015/5/13/pubmed PY - 2016/8/3/medline SP - 1415 EP - 24 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet. Med. VL - 32 IS - 11 N2 - AIM: Continuous subcutaneous insulin infusion (CSII) is increasingly used in clinical practice for the management of selected patients with Type 1 diabetes. Several cost-effectiveness studies comparing CSII vs. multiple insulin injections (MDI) have been reported. The aim was systematically to review these analyses and test the hypothesis that CSII is a cost-effective use of healthcare resources across settings. METHODS: A literature review was performed using MEDLINE, Cochrane Library and other databases. No time limit or language restrictions were applied. After two rounds of screening, 11 cost-effectiveness analyses were included in the final review, of which nine used the CORE Diabetes Model. A narrative synthesis was conducted and mean cost effectiveness calculated. RESULTS: CSII was considered cost-effective vs. MDI in Type 1 diabetes in all 11 studies in 8 countries, with a mean (95% CI) incremental cost effectiveness ratio of €30 862 (17 997-43 727), US$40 143 (23 409-56 876) per quality-adjusted life year (QALY) gained. CSII was associated with improved life expectancy and quality-adjusted life expectancy (0.4-1.1 QALYs in adults), driven by lower HbA(1c) and lower frequency of hypoglycaemic events vs. MDI. CSII was associated with higher lifetime direct costs due to higher treatment costs but this was partially offset by cost-savings from reduced diabetes-related complications. CONCLUSIONS: Published cost-effectiveness analyses show that in Type 1 diabetes CSII is cost-effective vs. MDI across a number of settings for patients who have poor glycaemic control and/or problematic hypoglycaemia on MDI, with cost-effectiveness highly sensitive to the reduction in HbA1c and hypoglycaemia frequency associated with CSII. SN - 1464-5491 UR - https://www.unboundmedicine.com/medline/citation/25962621/Cost_effectiveness_of_continuous_subcutaneous_insulin_infusion_versus_multiple_daily_injections_of_insulin_in_Type_1_diabetes:_a_systematic_review_ L2 - https://doi.org/10.1111/dme.12792 DB - PRIME DP - Unbound Medicine ER -