title: Cost-effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections of insulin in Type 1 diabetes: a systematic review.
abstract: OBJECTIVE
  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.affiliation: HEVA HEOR, Lyon, France.
authors.forename: S
authors.initials: S
authors.lastname: Roze
authors.affiliation: Ossian Health Economics and Communications, Basel, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Smith-Palmer
authors.affiliation: Ossian Health Economics and Communications, Basel, Switzerland.
authors.forename: W
authors.initials: W
authors.lastname: Valentine
authors.affiliation: Medtronic International Sàrl, Tolochenaz, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: de Portu
authors.affiliation: Department of Endocrinology, Hvidovre University Hospital, Hvidovre, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Nørgaard
authors.affiliation: Diabetes Research Group, King's College London School of Medicine, Guy's Hospital, London, UK.
authors.forename: J C
authors.initials: JC
authors.lastname: Pickup
mesh_terms: D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000191:economics / Q000517:prevention & control*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D019317:Evidence-Based Medicine; D006442:Glycated Hemoglobin / Q000032:analysis; D017048:Health Care Costs; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000009:adverse effects / Q000191:economics; D019057:Quality-Adjusted Life Years
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human