title: A cost-effectiveness analysis of sensor-augmented insulin pump therapy and automated insulin suspension versus standard pump therapy for hypoglycemic unaware patients with type 1 diabetes.
abstract: OBJECTIVE
  To assess the cost-effectiveness of sensor-augmented insulin pump therapy with "Low Glucose Suspend" (LGS) functionality versus standard pump therapy with self-monitoring of blood glucose in patients with type 1 diabetes who have impaired awareness of hypoglycemia.
  
  
  METHODS
  A clinical trial-based economic evaluation was performed in which the net costs and effectiveness of the two treatment modalities were calculated and expressed as an incremental cost-effectiveness ratio (ICER). The clinical outcome of interest for the evaluation was the rate of severe hypoglycemia in each arm of the LGS study. Quality-of-life utility scores were calculated using the three-level EuroQol five-dimensional questionnaire. Resource use costs were estimated using public sources.
  
  
  RESULTS
  After 6 months, the use of sensor-augmented insulin pump therapy with LGS significantly reduced the incidence of severe hypoglycemia compared with standard pump therapy (incident rate difference 1.85 [0.17-3.53]; P = 0.037). Based on a primary randomized study, the ICER per severe hypoglycemic event avoided was $18,257 for all patients and $14,944 for those aged 12 years and older. Including all major medical resource costs (e.g., hospital admissions), the ICERs were $17,602 and $14,289, respectively. Over the 6-month period, the cost per quality-adjusted life-year gained was $40,803 for patients aged 12 years and older.
  
  
  CONCLUSIONS
  Based on the Australian experience evaluating new interventions across a broad range of therapeutic areas, sensor-augmented insulin pump therapy with LGS may be considered a cost-effective alternative to standard pump therapy with self-monitoring of blood glucose in hypoglycemia unaware patients with type 1 diabetes.
authors.affiliation: Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia; Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia; School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.
authors.forename: Trang T
authors.initials: TT
authors.lastname: Ly
authors.affiliation: OPTUM, Asia Pacific Life Sciences, Lilyfield, NSW, Australia.
authors.forename: Alan J M
authors.initials: AJ
authors.lastname: Brnabic
authors.affiliation: Medtronic Australasia, North Ryde, NSW, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Eggleston
authors.affiliation: Medtronic Australasia, North Ryde, NSW, Australia.
authors.forename: Athena
authors.initials: A
authors.lastname: Kolivos
authors.affiliation: Medtronic Australasia, North Ryde, NSW, Australia.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: McBride
authors.affiliation: PRIMA Consulting Group Pty Ltd, Chatswood, NSW, Australia.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Schrover
authors.affiliation: Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia; Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia; School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia. Electronic address: tim.jones@health.wa.gov.au.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Jones
mesh_terms: D001315:Australia; D001786:Blood Glucose / Q000187:drug effects; D015190:Blood Glucose Self-Monitoring / Q000379:methods; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000175:diagnosis; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D015994:Incidence; D007328:Insulin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: cost-effectiveness; hypoglycemia; insulin pump therapy; type 1 diabetes