Economic Evaluation of Continuous Subcutaneous Insulin Infusion for Children with Diabetes—Part II

Abstract

The aim of this study is to assess long-term metabolic outcomes in children with diabetes mellitus and to compare the efficacy, feasibility and metabolic control expenses for treatment with continuous subcutaneous insulin infusion (CSII), compared to human insulin treatment. The study sample included 34 children aged 3 to 18 years with type 1 diabetes, 17 with continuous subcutaneous insulin infusion (CSII) therapy and 17 with standard treatment with human insulin. The study observed for the following variables: duration of the disease, diabetic control, HbA1c deviation scores; height and weight deviation and price of the treatment. Methods applied include meta-analyses in the published medical literature, pharmacoeconomic analysis and statistical analysis. From the 34 children with diabetes type 1 observed retrospectively during the period 1999-2012, 17 were on CSII (mean age 10 years, mean duration of the disease-7 years, average usage of CSII-3 years). The test stripes cost 533 Euro/year (1100 stripes per year) and their average cost according to the duration of the disease is 3779.45 Euro since diagnosis. The blood glucose monitoring system costs 20 Euro and for the duration of the disease-4.96 Euro per patient per year. The average improvement of HbA(1c) after the CSII introduction is 1.85, while after the application of human insulin-0.28. The treatment with CSII leads to significant improvement in glycemic control compared to the treatment with human insulin. The reduced HbA(1c) shows good diabetes management, from one point of view, and good quality of life-from another.

The Effect of Continuous Subcutaneous Insulin Infusion Treatment, Insulin Analog, and Human Insulin of Children With Diabetes

“…This study shows that the usage of insulin pump with child populations with type-1 diabetes is an efficient therapy, compared with the other two alternatives-on MDI or on human insulin with a pen device. The same results were also achieved by comparing the alternatives separately during the whole observed period (Petkova et al, 2013b) The study also shows that children using CSII manage to maintain stable and target HbA1c levels, which are preconditions for better diabetes management (UKPDS, DCCT). The studies of the CSII usage in child populations are very limited in terms of long-term results comparison in detail.…”

“…The results of this study and the results of our other studies (Petkova et al, 2013a;2013b) can serve as justification for the Bulgarian NHIF to include CSII in the reimbursement system.…”

“…Their parents also signed the informed consent. Partial results were reported separately for children on analogues insulin (Petrova et al, 2013a) and on human insulin (Petkova et al, 2013b). Due to the consequtive recruitment of the children in this study we compared the three patients groups to see the general picture.…”