Cost-effectiveness of the use of the continuous subcutaneous insulin infusion pump versus daily multiple injections in type 1 diabetes adult patients at the Mexican Institute of Social Security

Abstract

Background To estimate the incremental cost-effectiveness ratio (ICER) of the use of continuous subcutaneous insulin infusion (CSII) therapy versus multiple daily injections (MDI) therapy in adult patients with type 1 diabetes (T1D) at the Mexican Institute of Social Security (IMSS). Methods An analysis was developed using the internationally validated Core Diabetes Model (CDM) with which the incidence and progression of acute and chronic complications and the mortality of T1D was simulated throughout life. The baseline characteristics of the simulated cohorts were obtained from Mexican T1D adult patients aged ≥ 18 years that received care at two national IMSS medical centres in 2016. In the base case, the costs of the complications and treatment of the disease with both therapies were estimated in Mexican currency from the perspective of the institution, using Diagnosis Related Groups for outpatient and inpatient care. Utilities were taken from the international bibliography. In a secondary analysis, indirect costs were included using a human capital approach. The model used a lifetime time horizon, and a discount rate of 5% was applied for health outcomes and costs. A one-way sensitivity analysis was conducted on key variables and patient sub-groups; uncertainty was evaluated using a Cost-Effectiveness Acceptability Curve. Results The average age of the cohort was 32 years, with diabetes duration of 19 years, an average HbA1c of 9.2%; 29% were men. A gain of 0.614 Quality Adjusted Life Years (QALYs) was estimated with the use of CSII therapy. The estimated ICER was MXN$478,020 per QALY in the base case, and MXN$369,593 when indirect costs were considered. The sensitivity analysis showed that, in adult patients with HbA1c > 9.0%, the ICER was MXN$262,237. Conclusions This is the first economic evaluation study that compares CSII therapy versus MDI therapy for T1D adult patients in Mexico. The insulin pump therapy can be considered cost-effective in the context of the IMSS when considering a threshold of three GDPs per capita with 43.9% probability. Results improve substantially when patients have an HbA1c above 9%.

Clinical Outcome and Cost-Effectiveness Analysis of CSII Versus MDI in Children and Adolescent With Type 1 Diabetes Mellitus in a Public Health Care System of China

“…Under the scenarios of 30, 40, 50, and 60 years of time horizon simulation, ICER is lower than 3 times of Qingdao’s per capita GDP in 2019,however,under the scenarios of 30 and 40 years, ICER is more than 1.5 times of per capita GDP. The results of this study are consistent with other studies that evaluated the efficacy and ICER of insulin pump therapy in developed countries ( 34 , 36 , 37 ). The findings show that compared with MDI, long-term or even life-long CSII treatment has cost-effective advantages.…”

“…Our study shows that the usage of CSII is an more effective therapy, although it has a higher overall cost of treating children with T1DM, and confirms similar results reported in the literature on improving metabolic control, reducing the incidence of complications and improving quality of life (32)(33)(34)(35). Under the scenarios of 60 years of time horizon simulation, the long-term direct medical cost of the CSII group is only 67,137 yuan higher than that of the MDI group, because CSII treatment significantly reduces the treatment cost of diabetes-related complications, especially renal complications and severe hypoglycemia events.…”

Insulin Pump Therapy Issues Among Adults with Type 1 Diabetes Mellitus in Saudi Arabia: A Retrospective Study

“…Furthermore, 40 of the 118 subjects (33.8%) reported having either no significant change in frequency of hypoglyacaemic attacks or more hypoglycaemic attacks after CSII therapy. CSII has been highlighted in several health economic studies as being more cost effective than MDI, at least in adults [18,19], but not in children [20]. In the present study, the common issues encountered by the subjects regarding their medical devices should be reported to the Saudi Food and Drug Administration (SFDA) where approval of such devices takes place.…”

The improved survival rate and cost-effectiveness of a 7-day continuous subcutaneous insulin infusion set

“…The effectiveness and advantages of continuous subcutaneous insulin infusion (CSII) are well-established [20][21][22][23]. Studies performed on the economic value of CSIIs compared to multiple daily injections (MDI) have demonstrated cost-effectiveness at varying willingness-to-pay thresholds across a broad set of geographies [24][25][26][27].…”