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Real-world costs of continuous insulin pump therapy and multiple daily injections for type 1 diabetes : A population-based and propensity-matched cohort from the Swedish National Diabetes Register

Grip, Emilie Toresson LU ; Svensson, Ann Marie ; Miftaraj, Mervete ; Eliasson, Björn ; Franzén, Stefan ; Gudbjörnsdottir, Soffia and Carlsson, Katarina Steen LU (2019) In Diabetes Care 42(4). p.545-552
Abstract


OBJECTIVE To investigate real-world costs of continuous insulin pump therapy compared with multiple daily injection (MDI) therapy for type 1 diabetes. RESEARCH DESIGN AND METHODS Individuals with type 1 diabetes and pump therapy in the Swedish National Diabetes Register (NDR) since 2002 were eligible. Control subjects on MDI were matched 2:1 using time-varying propensity scores. Longitudinal data on health care resource use, antidiabetes treatment, sickness absence, and early retirement were taken from national registers for 2005–2013. Mean annual costs were analyzed using univariate analysis. Regression analyses explored the role of sociodemographic factors. Subgroup and... (More)


OBJECTIVE To investigate real-world costs of continuous insulin pump therapy compared with multiple daily injection (MDI) therapy for type 1 diabetes. RESEARCH DESIGN AND METHODS Individuals with type 1 diabetes and pump therapy in the Swedish National Diabetes Register (NDR) since 2002 were eligible. Control subjects on MDI were matched 2:1 using time-varying propensity scores. Longitudinal data on health care resource use, antidiabetes treatment, sickness absence, and early retirement were taken from national registers for 2005–2013. Mean annual costs were analyzed using univariate analysis. Regression analyses explored the role of sociodemographic factors. Subgroup and sensitivity analyses were performed. RESULTS A total of 14,238 individuals with type 1 diabetes entered in the NDR between 2005 and 2013 (insulin pump n = 4,991, MDI n = 9,247, with switches allowed during the study) were included. Mean age at baseline was 34 years, with 21 years of diabetes duration and a mean HbA
1c
of 8.1% (65 mmol/mol). We had 73,920 person-years of observation with a mean follow-up of 5 years per participant. Mean annual costs were higher for pump therapy than for MDI therapy ($12,928 vs. $9,005, respectively; P < 0.001; mean difference $3,923 [95% CI $3,703–$4,143]). Health care costs, including medications and disposables, accounted for 73% of the costs for pump therapy and 63% of the costs for MDI therapy. Regression analyses showed higher costs for low education, low disposable income, women, and older age. CONCLUSIONS Nine years of real-world data on all measurable diabetes-related resource use show robust results for additional costs of insulin pump therapy in adults by subgroup and alternative propensity score specifications. Identification of tangible and intangible benefits of pump therapy over time remain important to support resource allocation decisions.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Diabetes Care
volume
42
issue
4
pages
8 pages
publisher
American Diabetes Association
external identifiers
  • scopus:85063617317
  • pmid:30705062
ISSN
0149-5992
DOI
10.2337/dc18-1850
language
English
LU publication?
yes
id
5cb6aea9-628d-4d14-ad74-04830df4a474
date added to LUP
2019-04-09 10:37:52
date last changed
2019-04-30 04:10:42
@article{5cb6aea9-628d-4d14-ad74-04830df4a474,
  abstract     = {<p><br>
                                                         OBJECTIVE To investigate real-world costs of continuous insulin pump therapy compared with multiple daily injection (MDI) therapy for type 1 diabetes. RESEARCH DESIGN AND METHODS Individuals with type 1 diabetes and pump therapy in the Swedish National Diabetes Register (NDR) since 2002 were eligible. Control subjects on MDI were matched 2:1 using time-varying propensity scores. Longitudinal data on health care resource use, antidiabetes treatment, sickness absence, and early retirement were taken from national registers for 2005–2013. Mean annual costs were analyzed using univariate analysis. Regression analyses explored the role of sociodemographic factors. Subgroup and sensitivity analyses were performed. RESULTS A total of 14,238 individuals with type 1 diabetes entered in the NDR between 2005 and 2013 (insulin pump n = 4,991, MDI n = 9,247, with switches allowed during the study) were included. Mean age at baseline was 34 years, with 21 years of diabetes duration and a mean HbA                             <br>
                            <sub>1c</sub><br>
                                                          of 8.1% (65 mmol/mol). We had 73,920 person-years of observation with a mean follow-up of 5 years per participant. Mean annual costs were higher for pump therapy than for MDI therapy ($12,928 vs. $9,005, respectively; P &lt; 0.001; mean difference $3,923 [95% CI $3,703–$4,143]). Health care costs, including medications and disposables, accounted for 73% of the costs for pump therapy and 63% of the costs for MDI therapy. Regression analyses showed higher costs for low education, low disposable income, women, and older age. CONCLUSIONS Nine years of real-world data on all measurable diabetes-related resource use show robust results for additional costs of insulin pump therapy in adults by subgroup and alternative propensity score specifications. Identification of tangible and intangible benefits of pump therapy over time remain important to support resource allocation decisions.                         <br>
                        </p>},
  author       = {Grip, Emilie Toresson and Svensson, Ann Marie and Miftaraj, Mervete and Eliasson, Björn and Franzén, Stefan and Gudbjörnsdottir, Soffia and Carlsson, Katarina Steen},
  issn         = {0149-5992},
  language     = {eng},
  number       = {4},
  pages        = {545--552},
  publisher    = {American Diabetes Association},
  series       = {Diabetes Care},
  title        = {Real-world costs of continuous insulin pump therapy and multiple daily injections for type 1 diabetes : A population-based and propensity-matched cohort from the Swedish National Diabetes Register},
  url          = {http://dx.doi.org/10.2337/dc18-1850},
  doi          = {10.2337/dc18-1850},
  volume       = {42},
  year         = {2019},
}