Long-term health economic benefits of sensor-augmented pump therapy vs continuous subcutaneous insulin infusion alone in type 1 diabetes: a UK perspective

Abstract

Aims/hypothesis:

Continuous subcutaneous insulin infusion (CSII) is an important treatment option for type 1 diabetes patients unable to achieve adequate glycemic control with multiple daily injections (MDI). Combining CSII with continuous glucose monitoring (CGM) in sensor-augmented pump therapy (SAP) with a low glucose-suspend (LGS) feature may further improve glycemic control and reduce the frequency of hypoglycemia. A cost-effectiveness analysis of SAP + LGS vs CSII plus self-monitoring of blood glucose (SMBG) was performed to determine the health economic benefits of SAP + LGS in type 1 diabetes patients using CSII in the UK.

Methods:

Cost-effectiveness analysis was performed using the CORE diabetes model. Treatment effects were sourced from the literature, where SAP + LGS was associated with a projected HbA_1c reduction of −1.49% vs −0.62% for CSII, and a reduced frequency of severe hypoglycemia. The time horizon was that of patient lifetimes; future costs and clinical outcomes were discounted at 3.5% and 1.5% per annum, respectively.

Results:

Projected outcomes showed that SAP + LGS was associated with higher mean quality-adjusted life expectancy (17.9 vs 14.9 quality-adjusted life years [QALYs], SAP + LGS vs CSII), and higher life expectancy (23.8 vs 21.9 years), but higher mean lifetime direct costs (GBP 125,559 vs GBP 88,991), leading to an incremental cost-effectiveness ratio (ICER) of GBP 12,233 per QALY gained for SAP + LGS vs CSII. Findings of the base-case analysis remained robust in sensitivity analyses.

Conclusions/interpretation:

For UK-based type 1 diabetes patients with poor glycemic control, the use of SAP + LGS is likely to be cost-effective compared with CSII plus SMBG.

Keywords::

• Continuous subcutaneous insulin infusion
• Continuous glucose monitoring
• Sensor-augmented pump therapy
• Type 1 diabetes
• Cost-effectiveness

Transparency

Declaration of funding

This study was supported by funding from Medtronic International Trading Sàrl.

Declaration of financial/other relationships

SR is a current employee of HEVA HEOR, which has received consulting fees from Medtronic. JSP and WV are current employees of Ossian Health Economics and Communications, which has received consulting fees from Medtronic. MC and MJ are current employees of Medtronic UK. SP is a current employee of Medtronic International Trading Sàrl. JCP has received speaker and/or consultancy fees from Medtronic, Roche, Cequr and Cellnovo, manufacturers of insulin pumps and/or CGM systems. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.