Cost-Effectiveness of Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections in Patients with Poorly Controlled Type 2 Diabetes in Finland

Abstract

Introduction Although primarily utilized in type 1 diabetes, continuous subcutaneous insulin infusion (CSII) represents a useful treatment alternative for patients with type 2 diabetes who are unable to achieve good glycemic control despite optimization of multiple daily injections (MDI). The aim of the analysis reported here was to investigate the long-term cost-effectiveness of CSII versus MDI in type 2 diabetes patients with poor glycemic control in Finland. Methods The IQVIA CORE Diabetes Model was used to make long-term projections of the clinical and economic outcomes associated with CSII use in type 2 diabetes, based on clinical input data from the OpT2mise trial, which showed that CSII was associated with a 1.1% decrease in glycated hemoglobin (HbA1c) in patients with poor glycemic control at baseline. The analysis was performed from a societal perspective and the time horizon was that of patient lifetimes. Future costs and clinical outcomes were discounted at 3% per annum. Results Continuous subcutaneous insulin infusion was associated with a gain in quality-adjusted life expectancy of 0.32 quality-adjusted life-years (QALYs) compared with MDI (8.15 vs. 7.83 QALYs, respectively), as well as higher mean lifetime costs, resulting in an incremental cost-effectiveness ratio of Euro (EUR) 47,834 per QALY gained for CSII versus MDI. The higher treatment costs in the CSII group were partly mitigated by a 15% reduction in diabetes-related complication costs. Sensitivity analyses demonstrated that CSII was most cost-effective in patients with the highest baseline HbA1c values. Conclusion In Finland, CSII is likely to represent a cost-effective treatment alternative for patients with type 2 diabetes with poor glycemic control despite optimization of MDI. In such patients, CSII is associated with improved clinical outcomes relative to MDI, with the higher acquisition costs partly offset by a lower lifetime incidence and cost of diabetes-related complications. Funding Medtronic International Sàrl.

Insulin Pump Therapy Issues Among Adults with Type 1 Diabetes Mellitus in Saudi Arabia: A Retrospective Study

“…Furthermore, 40 of the 118 subjects (33.8%) reported having either no significant change in frequency of hypoglyacaemic attacks or more hypoglycaemic attacks after CSII therapy. CSII has been highlighted in several health economic studies as being more cost effective than MDI, at least in adults [18,19], but not in children [20]. In the present study, the common issues encountered by the subjects regarding their medical devices should be reported to the Saudi Food and Drug Administration (SFDA) where approval of such devices takes place.…”

Costs of Continuous Subcutaneous Insulin Infusion and Multiple-Dose Insulin Therapies for Type 1 Diabetes Mellitus: A Review of Health Economics Studies

“…In the sensitivity analyses carried out in Finland, Literatura optimistic and pessimistic estimates were performed on a set of variables with an impact on investment return. The results suggested that CSII is more economical in patients with higher baseline HbA1c levels (ROZE et al, 2019). On the other hand, in the United Kingdom, the benefit of the use of CSII therapy is for those who have more than two glycemic severe events per year (17.4 events over eight years) and require hospital treatment at least once every eight months due to hypoglycemia symptoms (SCUFFHAM P and CARR L, 2003).…”

Use of insulin pumps and closed‐loop systems among people living with diabetes: A narrative review of clinical and cost‐effectiveness to enable access to technology and meet the needs of payers

“…In these studies, CSII was associated with a gain in QALYs ranging between 0.17 and 0.43 compared with MDI. Furthermore, higher mean lifetime costs were estimated, but these costs were mitigated due to the reduction in short‐ and long‐term diabetes complications 61‐63 . Indeed, treatment costs in the CSII group were compensated by a 15% to 20% reduction in diabetes‐related complication costs.…”