title: Health economic comparison between continuous subcutaneous insulin infusion and multiple daily injections of insulin for the treatment of adult type 1 diabetes in Canada.
abstract: BACKGROUND
  Patients with type 1 diabetes mellitus (DM) may be treated with insulin via multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII).
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the projected long-term cost-effectiveness of CSII compared with MDI by modeling a simulated sample of adult patients with type 1 DM in Canada.
  
  
  METHODS
  A health economic model was used to determine the incremental cost-effectiveness ratio (ICER) of CSII compared with MDI from the perspective of a Canadian provincial government. The primary input variable was change in glycosylated hemoglobin (HbA(1c)). A series of Markov constructs also simulated the progression of disease-related complications. Annual acquisition costs for CSII and MDI were year-2006 Can $6347.18 and Can $4649.69, respectively. A 60-year time horizon and a discount rate of 5.0% per annum on costs and clinical outcomes were used.
  
  
  RESULTS
  Mean direct lifetime costs were Can $15,591 higher with CSII treatment than MDI. Treatment with CSII was associated with an improvement in discounted life expectancy of 0.655 quality-adjusted life-years (QALYs) over a 60-year time horizon, compared with MDI (mean [SD], 10.029 [0.133] vs 9.374 [0.076] QALYs). ICERs were Can $27,264 per life-year gained and Can $23,797 per QALY for CSII compared with MDI. The results were most sensitive to HbA(1c) assumptions.
  
  
  CONCLUSIONS
  Based on this analysis, CSII may be a cost-effective treatment option when compared with MDI in adult patients with type 1 DM in Canada.
authors.affiliation: IMS Health Inc., Falls Church, Virginia 22046, USA.
authors.forename: Meaghan E
authors.initials: ME
authors.lastname: St Charles
authors.forename: Hamid
authors.initials: H
authors.lastname: Sadri
authors.forename: Michael E
authors.initials: ME
authors.lastname: Minshall
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Tunis
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002170:Canada; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000191:economics / Q000628:therapy; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000191:economics*; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D005380:Financing, Government; D006442:Glycated Hemoglobin / Q000378:metabolism; D017048:Health Care Costs; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000191:economics*; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000191:economics*; D007332:Insulin Infusion Systems / Q000191:economics*; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human