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Cost-effectiveness of sensor-augmented pump therapy versus standard insulin pump therapy in patients with type 1 diabetes in Denmark

Roze, S.; de Portu, S.; Smith-Palmer, J.; Delbaere, A.; Valentine, W. and Ridderstråle, M. LU (2017) In Diabetes Research and Clinical Practice 128. p.6-14
Abstract

Aims The use of continuous subcutaneous insulin infusion (CSII) in type 1 diabetes (T1D) has increased in recent years. Sensor-augmented pump therapy (SAP) with low glucose suspend (LGS) (allowing temporary suspension of insulin delivery if blood glucose level falls below a pre-defined threshold level) provides additional benefits over CSII alone, but is associated with higher acquisition costs. Therefore, a cost-effectiveness analysis of SAP + LGS versus CSII in patients with T1D was performed. Methods Analyses were performed using the CORE Diabetes Model in two different patient cohorts in Denmark, one with hyperglycemia at baseline and one with increased risk for hypoglycemic events. Clinical input data were sourced from published... (More)

Aims The use of continuous subcutaneous insulin infusion (CSII) in type 1 diabetes (T1D) has increased in recent years. Sensor-augmented pump therapy (SAP) with low glucose suspend (LGS) (allowing temporary suspension of insulin delivery if blood glucose level falls below a pre-defined threshold level) provides additional benefits over CSII alone, but is associated with higher acquisition costs. Therefore, a cost-effectiveness analysis of SAP + LGS versus CSII in patients with T1D was performed. Methods Analyses were performed using the CORE Diabetes Model in two different patient cohorts in Denmark, one with hyperglycemia at baseline and one with increased risk for hypoglycemic events. Clinical input data were sourced from published literature. The analysis was performed over a lifetime time horizon from a societal perspective. Future costs and clinical outcomes were discounted at 3% per annum. Results In patients who were hyperglycemic at baseline the use of SAP + LGS versus CSII resulted in improved quality-adjusted life expectancy (12.44 versus 10.99 quality-adjusted life years [QALYs]) but higher mean lifetime costs (DKK 2,027,316 versus DKK 1,801,293) leading to an incremental cost-effectiveness ratio (ICER) of DKK 156,082 per QALY gained. For patients at increased risk for hypoglycemic events the ICER for SAP + LGS versus CSII was DKK 89,868 per QALY gained. Conclusions The ICER for SAP + LGS versus CSII falls below commonly cited willingness-to-pay thresholds. Therefore, in Denmark, the use of SAP + LGS is likely to be considered cost-effective relative to CSII for patients with T1D who are either hyperglycemic, despite CSII use, or who experience frequent severe hypoglycemic events.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cost-effectiveness, Denmark, Hyperglycemia, Hypoglycemia, Sensor-augmented pump therapy, Type 1 diabetes
in
Diabetes Research and Clinical Practice
volume
128
pages
9 pages
publisher
Elsevier
external identifiers
  • scopus:85018499710
  • wos:000402469500002
ISSN
0168-8227
DOI
10.1016/j.diabres.2017.02.009
language
English
LU publication?
yes
id
330a8376-fb79-42b1-8899-5c542b44503c
date added to LUP
2017-05-24 14:13:06
date last changed
2017-09-18 11:37:19
@article{330a8376-fb79-42b1-8899-5c542b44503c,
  abstract     = {<p>Aims The use of continuous subcutaneous insulin infusion (CSII) in type 1 diabetes (T1D) has increased in recent years. Sensor-augmented pump therapy (SAP) with low glucose suspend (LGS) (allowing temporary suspension of insulin delivery if blood glucose level falls below a pre-defined threshold level) provides additional benefits over CSII alone, but is associated with higher acquisition costs. Therefore, a cost-effectiveness analysis of SAP + LGS versus CSII in patients with T1D was performed. Methods Analyses were performed using the CORE Diabetes Model in two different patient cohorts in Denmark, one with hyperglycemia at baseline and one with increased risk for hypoglycemic events. Clinical input data were sourced from published literature. The analysis was performed over a lifetime time horizon from a societal perspective. Future costs and clinical outcomes were discounted at 3% per annum. Results In patients who were hyperglycemic at baseline the use of SAP + LGS versus CSII resulted in improved quality-adjusted life expectancy (12.44 versus 10.99 quality-adjusted life years [QALYs]) but higher mean lifetime costs (DKK 2,027,316 versus DKK 1,801,293) leading to an incremental cost-effectiveness ratio (ICER) of DKK 156,082 per QALY gained. For patients at increased risk for hypoglycemic events the ICER for SAP + LGS versus CSII was DKK 89,868 per QALY gained. Conclusions The ICER for SAP + LGS versus CSII falls below commonly cited willingness-to-pay thresholds. Therefore, in Denmark, the use of SAP + LGS is likely to be considered cost-effective relative to CSII for patients with T1D who are either hyperglycemic, despite CSII use, or who experience frequent severe hypoglycemic events.</p>},
  author       = {Roze, S. and de Portu, S. and Smith-Palmer, J. and Delbaere, A. and Valentine, W. and Ridderstråle, M.},
  issn         = {0168-8227},
  keyword      = {Cost-effectiveness,Denmark,Hyperglycemia,Hypoglycemia,Sensor-augmented pump therapy,Type 1 diabetes},
  language     = {eng},
  month        = {06},
  pages        = {6--14},
  publisher    = {Elsevier},
  series       = {Diabetes Research and Clinical Practice},
  title        = {Cost-effectiveness of sensor-augmented pump therapy versus standard insulin pump therapy in patients with type 1 diabetes in Denmark},
  url          = {http://dx.doi.org/10.1016/j.diabres.2017.02.009},
  volume       = {128},
  year         = {2017},
}