title: Cost-Effectiveness of Sensor-Augmented Pump Therapy with Low Glucose Suspend Versus Standard Insulin Pump Therapy in Two Different Patient Populations with Type 1 Diabetes in France.
abstract: BACKGROUND
  Sensor-augmented pump therapy (SAP) provides a useful adjunct relative to continuous subcutaneous insulin infusion (CSII) alone. It can provide early warning of the onset of hyperglycemia and hypoglycemia and has the functionality to suspend insulin delivery if sensor glucose levels fall below a predefined threshold. The aim was to assess the cost-effectiveness of SAP with low glucose suspend (LGS) versus CSII alone in type 1 diabetes.
  
  
  METHODS
  Cost-effectiveness analysis was performed using the CORE Diabetes Model, using published clinical input data. The analysis was performed in two cohorts: one with uncontrolled glycated hemoglobin at baseline and one at elevated risk for hypoglycemic events. The analysis was conducted from a healthcare payer perspective over a lifetime time horizon; future costs and clinical outcomes were discounted at 4% per annum.
  
  
  RESULTS
  In patients with uncontrolled glycated hemoglobin at baseline, SAP + LGS resulted in improved discounted quality-adjusted life expectancy (QALE) versus CSII (10.55 quality-adjusted life-years [QALYs] vs. 9.36 QALYs) but higher mean lifetime direct costs (€84,972 vs. €49,171) resulting in an incremental cost-effectiveness ratio (ICER) of €30,163 per QALY gained. In patients at elevated risk for hypoglycemia, the ICER was €22,005 per QALY gained for SAP + LGS versus CSII as lifetime costs were higher (€88,680 vs. €57,097), but QALE was also higher (18.46 QALYs vs. 18.30 QALYs).
  
  
  CONCLUSIONS
  In France, projected improvements in outcomes with SAP + LGS versus CSII translated into an ICER generally considered as good value for money, particularly in patients who experience frequent and/or problematic hypoglycemic events.
authors.affiliation: 1 HEVA HEOR , Lyon, France .
authors.forename: Stéphane
authors.initials: S
authors.lastname: Roze
authors.affiliation: 2 Ossian Health Economics and Communications , Basel, Switzerland .
authors.forename: Jayne
authors.initials: J
authors.lastname: Smith-Palmer
authors.affiliation: 2 Ossian Health Economics and Communications , Basel, Switzerland .
authors.forename: William
authors.initials: W
authors.lastname: Valentine
authors.affiliation: 3 Department of Health Economics & Reimbursement, Medtronic France SAS , Boulogne Billancourt, France .
authors.forename: Vincent
authors.initials: V
authors.lastname: Payet
authors.affiliation: 4 Medtronic International Trading Sàrl , Tolochenaz, Switzerland .
authors.forename: Simona
authors.initials: S
authors.lastname: de Portu
authors.affiliation: 4 Medtronic International Trading Sàrl , Tolochenaz, Switzerland .
authors.forename: Natalie
authors.initials: N
authors.lastname: Papo
authors.affiliation: 5 UMR CNRS 5558, Laënnec Faculty of Medicine , Lyon, France .
authors.forename: Michel
authors.initials: M
authors.lastname: Cucherat
authors.affiliation: 6 Department of Cardiovascular & Metabolic, Toulouse University Hospital Center , Toulouse, France .
authors.forename: Helene
authors.initials: H
authors.lastname: Hanaire
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000191:economics*; D005260:Female; D005602:France; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D007003:Hypoglycemia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000191:economics*; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human