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Value Health. 2014 Jul;17(5):561-9. doi: 10.1016/j.jval.2014.05.008. Epub 2014 Jul 15.

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.

Author information

1
Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia; Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia; School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.
2
OPTUM, Asia Pacific Life Sciences, Lilyfield, NSW, Australia.
3
Medtronic Australasia, North Ryde, NSW, Australia.
4
PRIMA Consulting Group Pty Ltd, Chatswood, NSW, Australia.
5
Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia; Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia; School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia. Electronic address: tim.jones@health.wa.gov.au.

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.

KEYWORDS:

cost-effectiveness; hypoglycemia; insulin pump therapy; type 1 diabetes

PMID:
25128049
DOI:
10.1016/j.jval.2014.05.008
[Indexed for MEDLINE]
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