Cost-effectiveness analysis of continuous subcutaneous insulin infusion versus multiple daily insulin for treatment of children with type 1 diabetes

ABSTRACT

Objective

To evaluate the health economics of using continuous subcutaneous insulin infusion (CSII) therapy versus multiple daily injections (MDI) therapy in children and adolescent patients with type 1 diabetes (T1D) in Qingdao, China.

Methods

A long-term cost-effectiveness analysis was conducted using the IQVIA Core Diabetes Model (CDM). The baseline characteristics of the simulated cohorts were obtained from 213 pediatric T1D patients who received care with CSII(104 cases) or MDI(109 cases) in Qingdao from 1 January 2015 to 31 March 2019. In the essential case, the expenditure of the complications and treatment of the disease with both therapies were evaluated in Chinese currency from the perspective of healthcare system. In a secondary analysis, the model used a 70-year time horizon, and a discount rate of 5% was applied to all future health outcomes and costs. A one-way sensitivity analysis was conducted on delta HbA1c, different prices of insulin pump, price of each upgrade cycle rates and different discount rates. Uncertainty was also evaluated by the probability sensitivity analysis and scenario analysis.

Results

In the base-case analysis, the lifetime total costs were lower for CSII group at ¥630,871 per patient compared with ¥672,672 for MDI group. The quality-adjusted life years (QALYs) gained were 11.612 and 11.197 for patients treated with CSII group and MDI group, respectively. The CSII group was cost-saving compared to MDI group. The feasibility of CSII group being cost-effective was 100% under the threshold of 3 times per capita GDP of China in 2019 (¥212,676) which was indicated from the probabilistic sensitivity analysis. Regarding scenario analysis, the ICER of the CSII group compared to MDI was between −151,583 and 153,366 RMB/QALYs, which is cost-effective.

Conclusions

This economic evaluation compared CSII therapy versus MDI therapy for T1D children and adolescent patients in China and findings indicate that CSII should be considered a preferred treatment modality to MDI.

KEYWORDS:

• Continuous subcutaneous insulin infusion
• multiple daily injections
• cost-effectiveness
• type 1 diabetes

Authors’ contributions

Zhihong Chen conceptualized the study, performed the literature review. Lijuan Zhang wrote the first draft of the manuscript; Xuefei Leng and Fei Tian participated in the literature collection and evaluation; Dunming Xiao and Jianwei Xuan supervised and critically revised the manuscript; Hongxiu Yang and Jing Liu gave a scientific contribution. All authors read and approved the final manuscript.

Acknowledgments

Thank you very much for the strong support of Medtronic.

Disclosure statement

Authors have no financial/other conflicts of interest to declare. A peer reviewer on this manuscript is an employee and shareholder of Eli Lilly and Company, a company that makes insulin for T1D. Peer reviewers have no other financial/other conflicts of interest to declare.

Additional information

Funding

No funding was received for the production of this manuscript.