[Cost-effectiveness of continuous subcutaneous insulin infusion therapy for type 1 diabetes].
BACKGROUND
This study's aim was to project the long-term clinical and economic outcomes of continuous subcutaneous insulin infusion (CSII) treatment compared to multiple daily injections (MDI) in type 1 diabetes patients in Denmark.


METHODS
The CORE diabetes model was used to project life expectancy, quality-adjusted life expectancy, cumulative incidence of diabetes-related complications and costs over patient lifetimes. The simulated cohort was based upon a recent meta-analysis of CSII treatment from over 50 studies. Direct and indirect costs (human capital approach) from a healthcare payer perspective were accounted in year 2005 local currency. Outcomes were discounted according to recommendations and simulations performed over a 60 year time horizon.


RESULTS
CSII treatment was associated with improved life expectancy, quality-adjusted life expectancy and reduced incidence of most diabetes-related complications compared to MDI. In the base case analysis, lifetime costs were higher for CSII than for MDI with incremental cost-effectiveness ratios in terms of cost per quality-adjusted life year gained within the range generally considered good value for money. Sensitivity analyses revealed that the findings were most sensitive to variation in assumptions regarding time horizon and hypoglycaemic event rate.


CONCLUSIONS
CSII led to improved long-term clinical outcomes due to improved glycaemic control versus MDI. Evaluation of the economic impact of CSII treatment versus MDI demonstrated that it would be likely to represent good value for money by currently accepted standards.
Nørgaard
Kirsten
K
Hvidovre Hospital, Endokrinologisk Afdeling, Medtronic AB, Järfälla, Sverige. kirsten.noergaard@hvh.regionh.dk
Sohlberg
Anna
A
Goodall
Gordan
G
D000328:Adult; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000175:diagnosis / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D017048:Health Care Costs; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems / Q000191:economics*; D008017:Life Expectancy; D008297:Male; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin