A Cost-Effectiveness Analysis of Sensor-Augmented Insulin Pump Therapy and Automated Insulin Suspension versus Standard Pump Therapy for Hypoglycemic Unaware Patients with Type 1 Diabetes

• Published in: Value in health 2014-07, Vol.17 (5), p.561-569
• Main Authors: Ly, Trang T., MBBS, DCH, FRACP, Brnabic, Alan J.M., MA Statistics, Eggleston, Andrew, BPharm, MMedSc (clin epi), Kolivos, Athena, BPharm, MCom, MA, MPH, McBride, Margaret E., PhD, Schrover, Rudolf, MSc, Jones, Timothy W., MBBS, FRACP, MD
• Format: Article
• Language: English
• Subjects: Australia; Biological and medical sciences; Blood Glucose - drug effects; Blood Glucose Self-Monitoring - methods; Cost-Benefit Analysis; cost-effectiveness; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - economics; General aspects; Humans; hypoglycemia; Hypoglycemia - chemically induced; Hypoglycemia - diagnosis; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - economics; Hypoglycemic Agents - therapeutic use; Incidence; Insulin - administration & dosage; Insulin - economics; Insulin - therapeutic use; Insulin Infusion Systems; insulin pump therapy; Internal Medicine; Medical sciences; Miscellaneous; Planification. Prevention (methods). Intervention. Evaluation; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Life; Quality-Adjusted Life Years; Randomized Controlled Trials as Topic; Severity of Illness Index; Surveys and Questionnaires; type 1 diabetes
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2014.05.008

Abstract Objective To assess the cost-effectiveness of sensor-augmented insulin pump therapy with “Low Glucose Suspend” (LGS) functionality versus standard pump therapy with self-monitoring of blood glucose in patients with type 1 diabetes who have impaired awareness of hypoglycemia. Methods A clinical trial–based economic evaluation was performed in which the net costs and effectiveness of the two treatment modalities were calculated and expressed as an incremental cost-effectiveness ratio (ICER). The clinical outcome of interest for the evaluation was the rate of severe hypoglycemia in each arm of the LGS study. Quality-of-life utility scores were calculated using the three-level EuroQol five-dimensional questionnaire. Resource use costs were estimated using public sources. Results After 6 months, the use of sensor-augmented insulin pump therapy with LGS significantly reduced the incidence of severe hypoglycemia compared with standard pump therapy (incident rate difference 1.85 [0.17–3.53]; P = 0.037). Based on a primary randomized study, the ICER per severe hypoglycemic event avoided was $18,257 for all patients and $14,944 for those aged 12 years and older. Including all major medical resource costs (e.g., hospital admissions), the ICERs were $17,602 and $14,289, respectively. Over the 6-month period, the cost per quality-adjusted life-year gained was $40,803 for patients aged 12 years and older. Conclusions Based on the Australian experience evaluating new interventions across a broad range of therapeutic areas, sensor-augmented insulin pump therapy with LGS may be considered a cost-effective alternative to standard pump therapy with self-monitoring of blood glucose in hypoglycemia unaware patients with type 1 diabetes.