Healthcare resource use, direct and indirect costs of hypoglycemia in type 1 and type 2 diabetes, and nationwide projections. Results of the HYPOS-1 study

Giorda, Carlo; Rossi, Maria Chiara; Ozzello, O.; Gentile, Sandro; Aglialoro, A.; Chiambretti, Anna; Baccetti, Fabio; Gentile, Francesco; Romeo, Francesco; Lucisano, Giuseppe; Nicolucci, Antonio; Fornengo, R.; Alessiato, A.; Ozzello, Alessandro; Sciangula, L; Musacchio, Nicoletta; Marelli, Giuseppe; Corsi, A.; Paciotti, V.; Iannarelli, R.; Antenucci, Daniela; Chiaramonte, F; Leotta, Sergio; Armentano, Vincenzo; Mastinu, F.; Cucinotta, Domenico

doi:10.1016/j.numecd.2016.10.005

Cited by 37 publications

(30 citation statements)

References 17 publications

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“…These results are important for patients with T1D for whom fear of hypoglycemia is often a barrier to glycemic control 40 . For patients with T2D, the results of this costeffectiveness analysis are relevant because direct medical costs related to hypoglycemia are generally greater than those for patients with T1D, due to more frequent hospitalizations and longer hospital stays 10 .…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of diabetes is increasing and, as a result, the direct and indirect costs of treatment (for example, the cost of insulin therapy, treatment for severe and non-severe hypoglycemia and other diabetes-related complications) represent a significant and growing economic burden for healthcare systems [8][9][10] . A cost-effectiveness analysis (CEA) can be used as a tool for economic decision-makers, payers, and clinicians to assess the cost of treating diabetes with newer therapies compared with existing treatments.…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of switching to insulin degludec from other basal insulins in real-world clinical practice in Italy

Haldrup

Lapolla

Gundgaard

et al. 2019

Journal of Medical Economics

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Aims: The costs associated with insulin therapy and diabetes-related complications represent a significant and growing economic burden for healthcare systems. The aim of this study was to evaluate the cost-effectiveness of switching to insulin degludec (degludec) vs continuing previous basal insulin, in Italian patients with type 1 (T1D) or type 2 (T2D) diabetes, using a long-term economic model. Materials and methods: Data were retrieved from a real-world population of patients from clinical practice in Italy. Clinical parameters included in the base-case model were change from baseline in HbA 1c , rates of hypoglycemia, and basal and bolus insulin dose, at 6 months following switch to degludec. Costs of treatments were taken from official Italian pharmaceutical list prices and costs of hypoglycemia were based on the literature. The data were used to populate a long-term (lifetime) IQVIA CORE Diabetes Model to evaluate the incremental cost-effectiveness ratio (ICER)cost per qualityadjusted life-year (QALY). The robustness of these results was tested with extensive sensitivity analyses by varying the time horizons and abolishing each of the treatment differences and previous basal insulins. Results: The total incremental cost for degludec vs previous basal insulin was e-6,310 and e-2,682 for patients with T1D and T2D, respectively; the switch to degludec resulted in a QALY gain of 0.781 and 0.628. The long-term ICER for degludec vs continuing the previous basal insulin regimen showed that degludec was dominant for both T1D and T2D, meaning that patient health was improved in terms of QALYs with lower healthcare costs. Sensitivity analyses showed that degludec remained dominant in most scenarios including after elimination of any benefit in non-severe hypoglycemia and insulin dose, in both T1D and T2D. Conclusions: Under routine care, switching to degludec is dominant, compared with continuing previous basal insulin, in Italian patients with T1D or T2D.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of switching to insulin degludec from other basal insulins in real-world clinical practice in Italy

Haldrup

Lapolla

Gundgaard

et al. 2019

Journal of Medical Economics

View full text Add to dashboard Cite

show abstract

“…In addition to the enormous cost (2-4 billion US dollars per year) for emergency room visits and hospitalization, [126][127][128][129] there is another cost to hypoglycemia. Brod [130][131][132] and coworkers have reported a series of studies showing the enormous economic, psychological, and loss-of-work-productivity costs of nonsevere hypoglycemia.…”

Section: Hypoglycemiamentioning

confidence: 99%

Continuous Glucose Monitoring: A Review of Recent Studies Demonstrating Improved Glycemic Outcomes

Rodbard¹

2017

Diabetes Technology & Therapeutics

357

267

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Continuous Glucose Monitoring (CGM) has been demonstrated to be clinically valuable, reducing risks of hypoglycemia and hyperglycemia, glycemic variability (GV), and improving patient quality of life for a wide range of patient populations and clinical indications. Use of CGM can help reduce HbA1c and mean glucose. One CGM device, with accuracy (%MARD) of approximately 10%, has recently been approved for selfadjustment of insulin dosages (nonadjuvant use) and approved for reimbursement for therapeutic use in the United States. CGM had previously been used off-label for that purpose. CGM has been demonstrated to be clinically useful in both type 1 and type 2 diabetes for patients receiving a wide variety of treatment regimens. CGM is beneficial for people using either multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). CGM is used both in retrospective (professional, masked) and real-time (personal, unmasked) modes: both approaches can be beneficial. When CGM is used to suspend insulin infusion when hypoglycemia is detected until glucose returns to a safe level (low-glucose suspend), there are benefits beyond sensor-augmented pump (SAP), with greater reduction in the risk of hypoglycemia. Predictive low-glucose suspend provides greater benefits in this regard. Closed-loop control with insulin provides further improvement in quality of glycemic control. A hybrid closed-loop system has recently been approved by the U.S. FDA. Closed-loop control using both insulin and glucagon can reduce risk of hypoglycemia even more. CGM facilitates rigorous evaluation of new forms of therapy, characterizing pharmacodynamics, assessing frequency and severity of hypo-and hyperglycemia, and characterizing several aspects of GV.

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“…Moreover, safe intensive diabetes management aimed at near‐normal glycemia is impossible without frequent and consistent glucose monitoring. However, most studies are small and do not include long‐term cost effectiveness, and few studies include pediatric diabetes …”

Section: Cost Of Care and Cost Benefit Analysismentioning

confidence: 99%

ISPAD Clinical Practice Consensus Guidelines 2018: The delivery of ambulatory diabetes care to children and adolescents with diabetes

et al. 2018

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Healthcare resource use, direct and indirect costs of hypoglycemia in type 1 and type 2 diabetes, and nationwide projections. Results of the HYPOS-1 study

Cited by 37 publications

References 17 publications

Cost-effectiveness of switching to insulin degludec from other basal insulins in real-world clinical practice in Italy

Cost-effectiveness of switching to insulin degludec from other basal insulins in real-world clinical practice in Italy

Continuous Glucose Monitoring: A Review of Recent Studies Demonstrating Improved Glycemic Outcomes

ISPAD Clinical Practice Consensus Guidelines 2018: The delivery of ambulatory diabetes care to children and adolescents with diabetes

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