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Cost-effectiveness of insulin pumps compared with multiple daily injections both provided with structured education for adults with type 1 diabetes: a health economic analysis of the Relative Effectiveness of Pumps over Structured Education (REPOSE) randomised controlled trial.
BMJ Open. 2018 04 07; 8(4):e016766.BO

Abstract

OBJECTIVES

To assess the long-term cost-effectiveness of insulin pumps and Dose Adjustment for Normal Eating (pumps+DAFNE) compared with multiple daily insulin injections and DAFNE (MDI+DAFNE) for adults with type 1 diabetes mellitus (T1DM) in the UK.

METHODS

We undertook a cost-utility analysis using the Sheffield Type 1 Diabetes Policy Model and data from the Relative Effectiveness of Pumps over Structured Education (REPOSE) trial to estimate the lifetime incidence of diabetic complications, intervention-based resource use and associated effects on costs and quality-adjusted life years (QALYs). All economic analyses took a National Health Service and personal social services perspective and discounted costs and QALYs at 3.5% per annum. A probabilistic sensitivity analysis was performed on the base case. Further uncertainties in the cost of pumps and the evidence used to inform the model were explored using scenario analyses.

SETTING

Eight diabetes centres in England and Scotland.

PARTICIPANTS

Adults with T1DM who were eligible to receive a structured education course and did not have a strong clinical indication or a preference for a pump.

INTERVENTION

Pumps+DAFNE.

COMPARATOR

MDI+DAFNE.

MAIN OUTCOME MEASURES

Incremental costs, incremental QALYs gained and incremental cost-effectiveness ratios (ICERs).

RESULTS

Compared with MDI+DAFNE, pumps+DAFNE was associated with an incremental discounted lifetime cost of +£18 853 (95% CI £6175 to £31 645) and a gain in discounted lifetime QALYs of +0.13 (95% CI -0.70 to +0.96). The base case mean ICER was £142 195 per QALY gained. The probability of pump+DAFNE being cost-effective using a cost-effectiveness threshold of £20 000 per QALY gained was 14.0%. All scenario and subgroup analyses examined indicated that the ICER was unlikely to fall below £30 000 per QALY gained.

CONCLUSIONS

Our analysis of the REPOSE data suggests that routine use of pumps in adults without an immediate clinical need for a pump, as identified by National Institute for Health and Care Excellence, would not be cost-effective.

TRIAL REGISTRATION NUMBER

ISRCTN61215213.

Authors+Show Affiliations

School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.Population Evidence and Technologies, Warwick Medical School, University of Warwick, Coventry, UK.Academic Unit of Diabetes, Endocrinology and Metabolism, Department of Oncology and Metabolism, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK.Academic Unit of Diabetes, Endocrinology and Metabolism, Department of Oncology and Metabolism, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK.Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.RTI Health Solutions, Manchester, UK.Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29627802

Citation

Pollard, Daniel John, et al. "Cost-effectiveness of Insulin Pumps Compared With Multiple Daily Injections Both Provided With Structured Education for Adults With Type 1 Diabetes: a Health Economic Analysis of the Relative Effectiveness of Pumps Over Structured Education (REPOSE) Randomised Controlled Trial." BMJ Open, vol. 8, no. 4, 2018, pp. e016766.
Pollard DJ, Brennan A, Dixon S, et al. Cost-effectiveness of insulin pumps compared with multiple daily injections both provided with structured education for adults with type 1 diabetes: a health economic analysis of the Relative Effectiveness of Pumps over Structured Education (REPOSE) randomised controlled trial. BMJ Open. 2018;8(4):e016766.
Pollard, D. J., Brennan, A., Dixon, S., Waugh, N., Elliott, J., Heller, S., Lee, E., Campbell, M., Basarir, H., & White, D. (2018). Cost-effectiveness of insulin pumps compared with multiple daily injections both provided with structured education for adults with type 1 diabetes: a health economic analysis of the Relative Effectiveness of Pumps over Structured Education (REPOSE) randomised controlled trial. BMJ Open, 8(4), e016766. https://doi.org/10.1136/bmjopen-2017-016766
Pollard DJ, et al. Cost-effectiveness of Insulin Pumps Compared With Multiple Daily Injections Both Provided With Structured Education for Adults With Type 1 Diabetes: a Health Economic Analysis of the Relative Effectiveness of Pumps Over Structured Education (REPOSE) Randomised Controlled Trial. BMJ Open. 2018 04 7;8(4):e016766. PubMed PMID: 29627802.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of insulin pumps compared with multiple daily injections both provided with structured education for adults with type 1 diabetes: a health economic analysis of the Relative Effectiveness of Pumps over Structured Education (REPOSE) randomised controlled trial. AU - Pollard,Daniel John, AU - Brennan,Alan, AU - Dixon,Simon, AU - Waugh,Norman, AU - Elliott,Jackie, AU - Heller,Simon, AU - Lee,Ellen, AU - Campbell,Michael, AU - Basarir,Hasan, AU - White,David, AU - ,, Y1 - 2018/04/07/ PY - 2018/4/9/entrez PY - 2018/4/9/pubmed PY - 2019/3/8/medline KW - general diabetes KW - health economics SP - e016766 EP - e016766 JF - BMJ open JO - BMJ Open VL - 8 IS - 4 N2 - OBJECTIVES: To assess the long-term cost-effectiveness of insulin pumps and Dose Adjustment for Normal Eating (pumps+DAFNE) compared with multiple daily insulin injections and DAFNE (MDI+DAFNE) for adults with type 1 diabetes mellitus (T1DM) in the UK. METHODS: We undertook a cost-utility analysis using the Sheffield Type 1 Diabetes Policy Model and data from the Relative Effectiveness of Pumps over Structured Education (REPOSE) trial to estimate the lifetime incidence of diabetic complications, intervention-based resource use and associated effects on costs and quality-adjusted life years (QALYs). All economic analyses took a National Health Service and personal social services perspective and discounted costs and QALYs at 3.5% per annum. A probabilistic sensitivity analysis was performed on the base case. Further uncertainties in the cost of pumps and the evidence used to inform the model were explored using scenario analyses. SETTING: Eight diabetes centres in England and Scotland. PARTICIPANTS: Adults with T1DM who were eligible to receive a structured education course and did not have a strong clinical indication or a preference for a pump. INTERVENTION: Pumps+DAFNE. COMPARATOR: MDI+DAFNE. MAIN OUTCOME MEASURES: Incremental costs, incremental QALYs gained and incremental cost-effectiveness ratios (ICERs). RESULTS: Compared with MDI+DAFNE, pumps+DAFNE was associated with an incremental discounted lifetime cost of +£18 853 (95% CI £6175 to £31 645) and a gain in discounted lifetime QALYs of +0.13 (95% CI -0.70 to +0.96). The base case mean ICER was £142 195 per QALY gained. The probability of pump+DAFNE being cost-effective using a cost-effectiveness threshold of £20 000 per QALY gained was 14.0%. All scenario and subgroup analyses examined indicated that the ICER was unlikely to fall below £30 000 per QALY gained. CONCLUSIONS: Our analysis of the REPOSE data suggests that routine use of pumps in adults without an immediate clinical need for a pump, as identified by National Institute for Health and Care Excellence, would not be cost-effective. TRIAL REGISTRATION NUMBER: ISRCTN61215213. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/29627802/Cost_effectiveness_of_insulin_pumps_compared_with_multiple_daily_injections_both_provided_with_structured_education_for_adults_with_type_1_diabetes:_a_health_economic_analysis_of_the_Relative_Effectiveness_of_Pumps_over_Structured_Education__REPOSE__randomised_controlled_trial_ L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&pmid=29627802 DB - PRIME DP - Unbound Medicine ER -