title: Cost-effectiveness of continuous subcutaneous insulin infusion in people with type 2 diabetes in the Netherlands.
abstract: OBJECTIVE
  Up to 30% of insulin-treated type 2 diabetes patients are unable to achieve HbA1c targets despite optimization of insulin multiple daily injections (MDI). For these patients the use of continuous subcutaneous insulin infusion (CSII) represents a useful but under-utilized alternative. The aim of the present analysis was to examine the cost-effectiveness of initiating CSII in type 2 diabetes patients failing to achieve good glycemic control on MDI in the Netherlands.
  
  
  METHODS
  Long-term projections were made using the IMS CORE Diabetes Model. Clinical input data were sourced from the OpT2mise trial. The analysis was performed over a lifetime time horizon. The discount rates applied to future costs and clinical outcomes were 4% and 1.5% per annum, respectively.
  
  
  RESULTS
  CSII was associated with improved quality-adjusted life expectancy compared with MDI (9.38 quality-adjusted life years [QALYs] vs 8.95 QALYs, respectively). The breakdown of costs indicated that ∼50% of costs were attributable to diabetes-related complications. Higher acquisition costs of CSII vs MDI were partially offset by the reduction in complications. The ICER was estimated at EUR 62,895 per QALY gained and EUR 60,474 per QALY gained when indirect costs were included.
  
  
  CONCLUSIONS
  In the Netherlands, CSII represents a cost-effective option in patients with type 2 diabetes who continue to have poorly-controlled HbA1c despite optimization of MDI. Since the ICER falls below the willingness-to-pay threshold of EUR 80,000 per QALY gained, CSII is likely to represent good-value for money in the treatment of poorly-controlled T2D patients compared with MDI.
authors.affiliation: a HEVA HEOR , Lyon , France ;
authors.forename: S
authors.initials: S
authors.lastname: Roze
authors.affiliation: a HEVA HEOR , Lyon , France ;
authors.forename: E
authors.initials: E
authors.lastname: Duteil
authors.affiliation: b Ossian Health Economics and Communications , Basel , Switzerland ;
authors.forename: J
authors.initials: J
authors.lastname: Smith-Palmer
authors.affiliation: c Medtronic International Sàrl , Tolochenaz , Switzerland ;
authors.forename: S
authors.initials: S
authors.lastname: de Portu
authors.affiliation: b Ossian Health Economics and Communications , Basel , Switzerland ;
authors.forename: W
authors.initials: W
authors.lastname: Valentine
authors.affiliation: d Medtronic plc , Eindhoven , The Netherlands ;
authors.forename: B F E
authors.initials: BF
authors.lastname: de Brouwer
authors.affiliation: e University of Caen Côte de Nacre Regional Hospital Center , Caen , France ;
authors.forename: Y
authors.initials: Y
authors.lastname: Reznik
authors.affiliation: f University Medical Centre Heidelberglaan , Utrecht , The Netherlands.
authors.forename: H W
authors.initials: HW
authors.lastname: de Valk
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000191:economics / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D009426:Netherlands; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Continuous subcutaneous insulin infusion; Cost; Cost-effectiveness; The Netherlands; Type 2 diabetes