Elsevier

Clinical Therapeutics

Volume 31, Issue 3, March 2009, Pages 657-667
Clinical Therapeutics

Health economic comparison between continuous subcutaneous insulin infusion and multiple daily injections of insulin for the treatment of adult type 1 diabetes in Canada

https://doi.org/10.1016/j.clinthera.2009.03.013Get rights and content

Abstract

Background: Patients with type 1 diabetes mellitus (DM) may be treated with insulin via multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII).

Objective: The purpose of this study was to evaluate the projected long-term cost-effectiveness of CSII compared with MDI by modeling a simulated sample of adult patients with type 1 DM in Canada.

Methods: A health economic model was used to determine the incremental cost-effectiveness ratio (ICER) of CSII compared with MDI from the perspective of a Canadian provincial government. The primary input variable was change in glycosylated hemoglobin (HbA1c). A series of Markov constructs also simulated the progression of disease-related complications. Annual acquisition costs for CSII and MDI were year-2006 Can $6347.18 and Can $4649.69, respectively. A 60-year time horizon and a discount rate of 5.0% per annum on costs and clinical outcomes were used.

Results: Mean direct lifetime costs were Can $15,591 higher with CSII treatment than MDI. Treatment with CSII was associated with an improvement in discounted life expectancy of 0.655 quality-adjusted life-years (QALYs) over a 60-year time horizon, compared with MDI (mean [SD], 10.029 [0.133] vs 9.374 [0.076] QALYs). ICERs were Can $27,264 per life-year gained and Can $23,797 per QALY for CSII compared with MDI. The results were most sensitive to HbA1c assumptions.

Conclusion: Based on this analysis, CSII may be a cost-effective treatment option when compared with MDI in adult patients with type 1 DM in Canada.

References (47)

  • AR Levy et al.

    Cost-effectiveness of beta-blocker therapy with metoprolol or with carvedilol for treatment of heart failure in Canada

    Am Heart J

    (2001)
  • AL Carrington et al.

    Psychological status of diabetic people with or without lower limb disability

    Diabetes Res Clin Pract

    (1996)
  • Diabetes Statistics. Juvenile Diabetes Research Foundation Australia 2006

  • Diabetes facts

  • NA Roper et al.

    Excess mortality in a population with diabetes and the impact of material deprivation: Longitudinal, population based study

    BMJ

    (2001)
  • MJ Lenhard et al.

    Continuous subcutaneous insulin infusion: A comprehensive review of insulin pump therapy

    Arch Intern Med

    (2001)
  • J Pickup et al.

    Glycaemic control with continuous subcutaneous insulin infusion compared with intensive insulin injections in patients with type 1 diabetes: Meta analysis of randomised controlled trials

    BMJ

    (2002)
  • J Weissberg-Benchell et al.

    Insulin pump therapy: A meta-analysis

    Diabetes Care

    (2003)
  • RP Hoogma et al.

    Comparison of the effects of continuous subcutaneous insulin infusion (CSII) and NPH-based multiple daily insulin injections (MDI) on glycaemic control and quality of life: Results of the 5-Nations Trial

    Diabet Med

    (2005)
  • JL Colquitt et al.

    Clinical and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes

    Health Technol Assess

    (2004)
  • P Scuffham et al.

    The cost-effectiveness of continuous subcutaneous insulin infusion compared with multiple daily injections for the management of diabetes

    Diabet Med

    (2003)
  • S Roze et al.

    Health-economic comparison of continuous subcutaneous insulin infusion with multiple daily injection for the treatment of type 1 diabetes in the UK

    Diabet Med

    (2005)
  • AJ Palmer et al.

    The CORE Diabetes Model: Projecting long-term clinical outcomes, costs and cost-effectiveness of interventions in diabetes mellitus (types 1 and 2) to support clinical and reimbursement decision-making

    Curr Med Res Opin

    (2004)
  • AJ Palmer et al.

    Validation of the CORE Diabetes Model against epidemiological and clinical studies

    Curr Med Res Opin

    (2004)
  • Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group [published correction appears in Lancet. 1999;354:602]

    Lancet

    (1998)
  • The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus

    N Engl J Med

    (1993)
  • DM Nathan et al.

    Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes

    N Engl J Med

    (2005)
  • CD Miller et al.

    Meeting American Diabetes Association guidelines in endocrinologist practice

    Diabetes Care

    (2000)
  • Bank of Canada. Inflation calculator

  • Hyperbaric oxygen therapy for non-healing ulcers in diabetes mellitus. Ontario Ministry of Health and Long-Term Care 2005

  • JA O'Brien et al.

    Cost of managing complications resulting from type 2 diabetes mellitus in Canada

    BMC Health Serv Res

    (2003)
  • D Coyle et al.

    Economic evaluation of pioglitazone hydrochloride in the management of type 2 diabetes mellitus in Canada

    PharmacoEconomics

    (2003)
  • Medical Procedure List. Alberta Health Care Insurance Plan

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    *

    Current affiliation: Center for Pharmacoeconomics and Outcomes Research, Lovelace Respiratory Research Institute, Kannapolis, North Carolina.

    Current affiliation: Covidien, North Haven, Connecticut.

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