title: Event and Cost Offsets of Switching 20% of the Type 1 Diabetes Population in Germany From Multiple Daily Injections to Continuous Subcutaneous Insulin Infusion: A 4-Year Simulation Model.
abstract: Most patients with type 1 diabetes (T1D) administer insulin by multiple daily injections (MDI). However, continuous subcutaneous insulin infusion (CSII) therapy has been shown to improve glycemic control compared with MDI.
  
  
  
  The objective was to determine the key medical event and cost offsets generated over a 4-year period by introducing CSII to T1D patients who have inadequately controlled glucose metabolism on MDI in Germany.
  
  
  
  A decision-analytic budget impact model, simulating a treatment switch scenario, was developed. In the base case, all T1D patients received MDI, while in the switch scenario, 20% of the eligible T1D population, randomly selected, moved to CSII. The model focused on 2 medical endpoints and their corresponding cost offsets: severe hypoglycemic events requiring hospitalization (SHEH) and complication-borne diabetic events (CDEs) avoided. Event rates and costs were taken from the literature and official sources, adopting a health insurance perspective.
  
  
  
  Compared with the base case, treating 20% of patients with CSII in the switch scenario resulted in 47 864 fewer SHEH and 5543 fewer CDEs. This led to total cost offsets of €183 085 281 within the 4-year time horizon. Of these, 92% were driven by avoided SHEH. Compared to an expected budget impact (cost increase) of 83%, only treatment costs considered, the total impact of the switch scenario amounted merely to a 24.5% increase in costs (reduction by 58.5% points; a factor of 3.4).
  
  
  
  The use of CSII resulted in fewer SHEH and CDEs compared to MDI. The incurred CSII implementation costs are hence offset to a substantial degree by cost savings in complication treatment.
authors.affiliation: Hamburg University of Applied Sciences, Hamburg, Germany yorkfrancis.zoellner@haw-hamburg.de.
authors.forename: York Francis
authors.initials: YF
authors.lastname: Zöllner
authors.affiliation: Diabetes Clinic for Children and Adolescents, Muenster, Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Ziegler
authors.affiliation: Johnson & Johnson Medical GmbH, Norderstedt, Germany.
authors.forename: Magnus
authors.initials: M
authors.lastname: Stüve
authors.affiliation: Econ-Epi, Wentorf/Hamburg, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Krumreich
authors.affiliation: Johnson & Johnson Medical GmbH, Norderstedt, Germany.
authors.forename: Marion
authors.initials: M
authors.lastname: Schauf
mesh_terms: D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000191:economics; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D055104:Infusions, Subcutaneous / Q000191:economics; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems / Q000191:economics*; D018803:Models, Economic
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: German costs data; budget impact; complication-borne diabetic events; continuous subcutaneous insulin infusion; glucose monitoring; severe hypoglycemic events; type 1 diabetes