Cost - Effectiveness of the use of the Insulin Pump Therapy Versus Daily Multiple Injections in Patients with Type 1 Diabetes at the Mexican Institute of Social Security

Abstract

Objectives: To conduct a cost-effectiveness analysis between Coblation and mechanical debridement with a shaver (MD) in a patient population presenting with chronic pain due to medial meniscus tear and an International Cartilage Research Society (ICRS) grade III focal chondral lesion. This analysis was conducted from the UK National Health Service (NHS) perspective. MethOds: A decisionanalytic model was developed to compare the net costs and clinical outcomes up to 4 years following surgery between patients whose knee chondroplasty procedure was carried out with Coblation or MD. Costs were obtained from the 2015-2016 UK NHS National schedule of reference costs and an annual 3% discount rate was applied to future costs. Clinical trial outcomes data included in the analysis were physiotherapy service utilization (6.4 units vs. 9.8 units; p= 0.04) and revision rates at 4 years (14% vs. 48%; p< 0.006) for both Coblation and MD respectively. Threshold analysis was used to determine the point at which the model conclusion changed while the robustness of the conclusions were assessed through deterministic sensitivity analyses. Results: Over a 4-year period following surgery, the use of Coblation vs. MD resulted in a £1,550 net savings per patient. The cost-saving realized with Coblation was robust to sensitivity analyses. Threshold analysis estimated that Coblation remained the dominant alternative when it was assumed that Coblation revision rate increased from the initially reported rate of 14% up to 68%. cOnclusiOns: The use of Coblation vs. MD in the treatment of cartilage lesions in a patient population with medial meniscus tear and ICRS grade III chondral lesion is cost-saving as a result of better clinical outcomes over a 4-year period following surgery.