Cost-Effectiveness Analysis of Sensor-Augmented Insulin Pump Therapy with Automated Insulin Suspension Versus Standard Insulin Pump Therapy in Patients with Type 1 Diabetes in Sweden

Abstract

IntroductionIn Sweden an estimated 10,000 people with type 1 diabetes use continuous subcutaneous insulin infusion (CSII). Sensor-augmented pump therapy (SAP) is associated with higher acquisition costs but provides additional clinical benefits (e.g. reduced rate of hypoglycemic events) over and above that of CSII alone. The aim of the analysis was to assess the cost-effectiveness of SAP with automated insulin suspension relative to CSII alone in two different groups of patients with type 1 diabetes in Sweden.MethodsCost-effectiveness analyses were performed using the QuintilesIMS CORE Diabetes Model, with clinical and economic input data derived from published literature. Separate analyses were performed for patients at increased risk of hypoglycemia and for patients with uncontrolled glycated hemoglobin (HbA1c) at baseline. Analyses were performed from a societal perspective over a lifetime time horizon. Future costs and clinical outcomes were discounted at 3% per annum.ResultsSAP with automated insulin suspension was associated with an incremental gain in quality-adjusted life expectancy versus the CSII of 1.88 quality-adjusted life years (QALYs) in patients at high risk of hypoglycemia and of 1.07 QALYs in patients with uncontrolled HbA1c at baseline. Higher lifetime costs for SAP with automated insulin suspension resulted in projected incremental cost-effectiveness ratios for the SAP with automated insulin suspension versus CSII of Swedish Krona (SEK) 139,795 [euros (EUR) 14,648] per QALY gained for patients at increased risk for hypoglycemia and SEK 251,896 (EUR 26,395) per QALY gained for patients with uncontrolled HbA1c. In both groups, SAP with automated insulin suspension also reduced the incidence of diabetes-related complications relative to CSII.ConclusionsIn Sweden, SAP with automated insulin suspension likely represents a cost-effective treatment option relative to CSII for the management of patients with type 1 diabetes with a history of severe hypoglycemic events or patients who struggle to achieve good glycemic control despite the use of CSII.FundingMedtronic International Trading Sàrl.

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

“…Regarding new technologies, cost‐effectiveness analyses are generally favorable. Recent studies in both Denmark and Sweden reported SAPs to be cost‐effective in patients at increased risk of hypoglycemia or with uncontrolled diabetes; the cost‐effectiveness increased with increase in HbA1c (with poorly controlled at baseline defined as HbA1c ≥8.1% (65 mmol/mol) . In the Danish study, additional indirect costs that could be considered include loss of driving license for those with recurrent hypoglycemia .…”

“…The additional cost per person with diabetes in children was 3930 Euros . Additional data on cost of diabetes care in children with both T1DM and T2DM and cost‐effective approaches to care are needed . Data on the effect of different care models and practices on long‐term outcomes are lacking and are essential to appropriate decisions in health care policy.…”

“…In the Danish study, additional indirect costs that could be considered include loss of driving license for those with recurrent hypoglycemia . Other studies have failed to demonstrate to show that these technologies are cost‐effective in adults, but may well be in children . It is important to assess cost‐effectiveness of new technologies in real‐life settings, particularly for children, as those associated with high upfront cost brings risk of deeper disparities in diabetes care.…”

“…Data are emerging rapidly on the use of such early forms of closed loop systems as low glucose suspend in children and implementation of more fully closed loop systems. 133 138,142 In the Danish study, additional indirect costs that could be considered include loss of driving license for those with recurrent hypoglycemia. 138 Other studies have failed to demonstrate to show that these technologies are cost-effective in adults, but may well be in children.…”

“…138 Other studies have failed to demonstrate to show that these technologies are cost-effective in adults, but may well be in children. 138,142,143 Access to health care can be a large challenge for poor children, more so in developing countries. Shortages of providers with diabetes expertise are widespread.…”