Long-term health economic benefits of sensor-augmented pump therapy vs continuous subcutaneous insulin infusion alone in type 1 diabetes: a U.K. perspective.
OBJECTIVE
Continuous subcutaneous insulin infusion (CSII) is an important treatment option for type 1 diabetes patients unable to achieve adequate glycemic control with multiple daily injections (MDI). Combining CSII with continuous glucose monitoring (CGM) in sensor-augmented pump therapy (SAP) with a low glucose-suspend (LGS) feature may further improve glycemic control and reduce the frequency of hypoglycemia. A cost-effectiveness analysis of SAP + LGS vs. CSII plus self-monitoring of blood glucose (SMBG) was performed to determine the health economic benefits of SAP + LGS in type 1 diabetes patients using CSII in the U.K.


METHODS
Cost-effectiveness analysis was performed using the CORE diabetes model. Treatment effects were sourced from the literature, where SAP + LGS was associated with a projected HbA1c reduction of -1.49% vs. -0.62% for CSII, and a reduced frequency of severe hypoglycemia. The time horizon was that of patient lifetimes; future costs and clinical outcomes were discounted at 3.5% and 1.5% per annum, respectively.


RESULTS
Projected outcomes showed that SAP + LGS was associated with higher mean quality-adjusted life expectancy (17.9 vs. 14.9 quality-adjusted life years [QALYs], SAP + LGS vs. CSII), and higher life expectancy (23.8 vs. 21.9 years), but higher mean lifetime direct costs (GBP 125,559 vs. GBP 88,991), leading to an incremental cost-effectiveness ratio (ICER) of GBP 12,233 per QALY gained for SAP + LGS vs. CSII. Findings of the base-case analysis remained robust in sensitivity analyses.


CONCLUSIONS
For UK-based type 1 diabetes patients with poor glycemic control, the use of SAP + LGS is likely to be cost-effective compared with CSII plus SMBG.
a a HEVA HEOR , Lyon , France.
Stéphane
S
Roze
b b Ossian Health Economics and Communications , Basel , Switzerland.
Jayne
J
Smith-Palmer
b b Ossian Health Economics and Communications , Basel , Switzerland.
William J
WJ
Valentine
c c Medtronic UK , Watford , UK.
Mark
M
Cook
c c Medtronic UK , Watford , UK.
Manisha
M
Jethwa
d d Medtronic International Trading Sàrl , Tolochenaz , Switzerland.
Simona
S
de Portu
e e Faculty of Life Sciences and Medicine , King's College London, Guy's Hospital , London , UK.
John C
JC
Pickup
D000328:Adult; D015190:Blood Glucose Self-Monitoring; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000191:economics*; D055104:Infusions, Subcutaneous / Q000191:economics*; D007328:Insulin / Q000008:administration & dosage* / Q000191:economics*; D007332:Insulin Infusion Systems / Q000191:economics*; D008297:Male; D009010:Monte Carlo Method; D019057:Quality-Adjusted Life Years
D007004:Hypoglycemic Agents; D007328:Insulin
Continuous glucose monitoring; Continuous subcutaneous insulin infusion; Cost-effectiveness; Sensor-augmented pump therapy; Type 1 diabetes