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

Abstract

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Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis

“…It should also be noted that the heterogeneity is not so much caused by qualitatively different results, but by quantitative differences. From these limitations it is clear that the results obtained from this meta-analysis have to be interpreted cautiously even though they are consistent with previously published meta-analyses [7,8,47,48].…”

“…Since in many of the included trials the different definitions of hypoglycaemia were susceptible to bias and the endpoint detection was not blinded, results on hypoglycaemic events have to be viewed as inherently uncertain. Like Pickup et al [7], Colquitt et al [47] and Weissberg-Benchell et al [48], we also did not perform a meta-analysis on hypoglycaemic events, due to differences in definitions of hypoglycaemic episodes, the difference in study duration, the small numbers of patients with severe hypoglycaemic episodes and the often missing measures of variance.…”

Improving management of type 1 diabetes in the UK: the Dose Adjustment For Normal Eating (DAFNE) programme as a research test-bed. A mixed-method analysis of the barriers to and facilitators of successful diabetes self-management, a health economic analysis, a cluster randomised controlled trial of different models of delivery of an educational intervention and the potential of insulin pumps and additional educator input to improve outcomes

“…This evidence may overstate the benefits of pump therapy as those who participate are already committed to intensive self-management or have a particular clinical need. 110 We hypothesise that many of the benefits of pumps may come from the retraining and education in insulin use given to allow patients to use pumps safely. In many DAFNE centres, reimbursement for pump use is conditional on patients having attended a DAFNE education course and so some patients undertake DAFNE training with the intention of moving to pump treatment thereafter.…”

Requisite models for strategic commissioning: the example of type 1 diabetes

“…hypoglycaemic events) and their flexibility of lifestyle. However, they are not currently considered costeffective because of their higher cost [83]. If all patients use insulin pumps (using the average annual cost from Colquitt et al [83]), the incremental cost of insulin prescribing and monitoring would be £515m in the short run (annualized figure over first 5 years) and £547m in the steady state.…”

“…However, they are not currently considered costeffective because of their higher cost [83]. If all patients use insulin pumps (using the average annual cost from Colquitt et al [83]), the incremental cost of insulin prescribing and monitoring would be £515m in the short run (annualized figure over first 5 years) and £547m in the steady state. This would consistently lower the net gains from Table 7; however, although this is an extreme and unrealistic assumption, the results would still be a loss in the short run (£470m net loss in output) and a gain in the steady state (£75 net gain in output).…”