Health economic comparison between continuous subcutaneous insulin infusion and multiple daily injections of insulin for the treatment of adult type 1 diabetes in Canada
Abstract Background: Patients with type 1 diabetes mellitus (DM) may be treated with insulin via multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). Objective: The purpose of this study was to evaluate the projected long-term cost-effectiveness of CSII compared with M...
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| Veröffentlicht in: | Clinical therapeutics 2009-03, Vol.31 (3), p.657-667 |
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| creator | Charles, Meaghan E.St., PhD Sadri, Hamid, PharmD, MSc Minshall, Michael E., MPH Tunis, Sandra L., PhD |
| description | Abstract Background: Patients with type 1 diabetes mellitus (DM) may be treated with insulin via multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). Objective: The purpose of this study was to evaluate the projected long-term cost-effectiveness of CSII compared with MDI by modeling a simulated sample of adult patients with type 1 DM in Canada. Methods: A health economic model was used to determine the incremental cost-effectiveness ratio (ICER) of CSII compared with MDI from the perspective of a Canadian provincial government. The primary input variable was change in glycosylated hemoglobin (HbA1c ). A series of Markov constructs also simulated the progression of disease-related complications. Annual acquisition costs for CSII and MDI were year-2006 Can $6347.18 and Can $4649.69, respectively. A 60-year time horizon and a discount rate of 5.0% per annum on costs and clinical outcomes were used. Results: Mean direct lifetime costs were Can $15,591 higher with CSII treatment than MDI. Treatment with CSII was associated with an improvement in discounted life expectancy of 0.655 quality-adjusted life-years (QALYs) over a 60-year time horizon, compared with MDI (mean [SD], 10.029 [0.133] vs 9.374 [0.076] QALYs). ICERs were Can $27,264 per life-year gained and Can $23,797 per QALY for CSII compared with MDI. The results were most sensitive to HbA1c assumptions. Conclusion: Based on this analysis, CSII may be a cost-effective treatment option when compared with MDI in adult patients with type 1 DM in Canada. |
| doi_str_mv | 10.1016/j.clinthera.2009.03.013 |
| format | Article |
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Objective: The purpose of this study was to evaluate the projected long-term cost-effectiveness of CSII compared with MDI by modeling a simulated sample of adult patients with type 1 DM in Canada. Methods: A health economic model was used to determine the incremental cost-effectiveness ratio (ICER) of CSII compared with MDI from the perspective of a Canadian provincial government. The primary input variable was change in glycosylated hemoglobin (HbA1c ). A series of Markov constructs also simulated the progression of disease-related complications. Annual acquisition costs for CSII and MDI were year-2006 Can $6347.18 and Can $4649.69, respectively. A 60-year time horizon and a discount rate of 5.0% per annum on costs and clinical outcomes were used. Results: Mean direct lifetime costs were Can $15,591 higher with CSII treatment than MDI. Treatment with CSII was associated with an improvement in discounted life expectancy of 0.655 quality-adjusted life-years (QALYs) over a 60-year time horizon, compared with MDI (mean [SD], 10.029 [0.133] vs 9.374 [0.076] QALYs). ICERs were Can $27,264 per life-year gained and Can $23,797 per QALY for CSII compared with MDI. The results were most sensitive to HbA1c assumptions. Conclusion: Based on this analysis, CSII may be a cost-effective treatment option when compared with MDI in adult patients with type 1 DM in Canada.</description><identifier>ISSN: 0149-2918</identifier><identifier>EISSN: 1879-114X</identifier><identifier>DOI: 10.1016/j.clinthera.2009.03.013</identifier><identifier>PMID: 19393856</identifier><language>eng</language><publisher>Bridgewater, NJ: EM Inc USA</publisher><subject>Adult ; Biological and medical sciences ; Biomarkers - blood ; Canada ; Computer Simulation ; continuous subcutaneous insulin infusion ; Cost analysis ; Cost-Benefit Analysis ; cost-effective ; Diabetes ; Diabetes Complications - economics ; Diabetes Complications - therapy ; Diabetes Mellitus, Type 1 - blood ; Diabetes Mellitus, Type 1 - drug therapy ; Diabetes Mellitus, Type 1 - economics ; Diabetes. Impaired glucose tolerance ; Drug Administration Schedule ; Drug Costs ; Economic models ; Economics ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; Financing, Government ; Glycated Hemoglobin A - metabolism ; Health Care Costs ; Humans ; Hypoglycemia ; Hypoglycemic Agents - administration & dosage ; Hypoglycemic Agents - economics ; Infusion pumps ; Injections, Subcutaneous ; Insulin ; Insulin - administration & dosage ; Insulin - economics ; Insulin Infusion Systems - economics ; Internal Medicine ; Life Expectancy ; Male ; Markov Chains ; Medical Education ; Medical sciences ; modeling ; Models, Economic ; Monte Carlo simulation ; multiple daily injections ; Pharmacology. Drug treatments ; Quality of life ; Quality-Adjusted Life Years ; Time Factors ; Treatment Outcome ; type 1 diabetes mellitus ; Young Adult</subject><ispartof>Clinical therapeutics, 2009-03, Vol.31 (3), p.657-667</ispartof><rights>Excerpta Medica Inc. All rights reserved.</rights><rights>2009 Excerpta Medica Inc. All rights reserved.</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c482t-ba5c9b09b1cac47f6675776097efb86600b4b8705aed4fc40460574ddbdf58443</citedby><cites>FETCH-LOGICAL-c482t-ba5c9b09b1cac47f6675776097efb86600b4b8705aed4fc40460574ddbdf58443</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1033160201?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72341</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21415952$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19393856$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Charles, Meaghan E.St., PhD</creatorcontrib><creatorcontrib>Sadri, Hamid, PharmD, MSc</creatorcontrib><creatorcontrib>Minshall, Michael E., MPH</creatorcontrib><creatorcontrib>Tunis, Sandra L., PhD</creatorcontrib><title>Health economic comparison between continuous subcutaneous insulin infusion and multiple daily injections of insulin for the treatment of adult type 1 diabetes in Canada</title><title>Clinical therapeutics</title><addtitle>Clin Ther</addtitle><description>Abstract Background: Patients with type 1 diabetes mellitus (DM) may be treated with insulin via multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). Objective: The purpose of this study was to evaluate the projected long-term cost-effectiveness of CSII compared with MDI by modeling a simulated sample of adult patients with type 1 DM in Canada. Methods: A health economic model was used to determine the incremental cost-effectiveness ratio (ICER) of CSII compared with MDI from the perspective of a Canadian provincial government. The primary input variable was change in glycosylated hemoglobin (HbA1c ). A series of Markov constructs also simulated the progression of disease-related complications. Annual acquisition costs for CSII and MDI were year-2006 Can $6347.18 and Can $4649.69, respectively. A 60-year time horizon and a discount rate of 5.0% per annum on costs and clinical outcomes were used. Results: Mean direct lifetime costs were Can $15,591 higher with CSII treatment than MDI. Treatment with CSII was associated with an improvement in discounted life expectancy of 0.655 quality-adjusted life-years (QALYs) over a 60-year time horizon, compared with MDI (mean [SD], 10.029 [0.133] vs 9.374 [0.076] QALYs). ICERs were Can $27,264 per life-year gained and Can $23,797 per QALY for CSII compared with MDI. The results were most sensitive to HbA1c assumptions. Conclusion: Based on this analysis, CSII may be a cost-effective treatment option when compared with MDI in adult patients with type 1 DM in Canada.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Canada</subject><subject>Computer Simulation</subject><subject>continuous subcutaneous insulin infusion</subject><subject>Cost analysis</subject><subject>Cost-Benefit Analysis</subject><subject>cost-effective</subject><subject>Diabetes</subject><subject>Diabetes Complications - economics</subject><subject>Diabetes Complications - therapy</subject><subject>Diabetes Mellitus, Type 1 - blood</subject><subject>Diabetes Mellitus, Type 1 - drug therapy</subject><subject>Diabetes Mellitus, Type 1 - economics</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Drug Administration Schedule</subject><subject>Drug Costs</subject><subject>Economic models</subject><subject>Economics</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Female</subject><subject>Financing, Government</subject><subject>Glycated Hemoglobin A - metabolism</subject><subject>Health Care Costs</subject><subject>Humans</subject><subject>Hypoglycemia</subject><subject>Hypoglycemic Agents - administration & dosage</subject><subject>Hypoglycemic Agents - economics</subject><subject>Infusion pumps</subject><subject>Injections, Subcutaneous</subject><subject>Insulin</subject><subject>Insulin - administration & dosage</subject><subject>Insulin - economics</subject><subject>Insulin Infusion Systems - economics</subject><subject>Internal Medicine</subject><subject>Life Expectancy</subject><subject>Male</subject><subject>Markov Chains</subject><subject>Medical Education</subject><subject>Medical sciences</subject><subject>modeling</subject><subject>Models, Economic</subject><subject>Monte Carlo simulation</subject><subject>multiple daily injections</subject><subject>Pharmacology. Drug treatments</subject><subject>Quality of life</subject><subject>Quality-Adjusted Life Years</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>type 1 diabetes mellitus</subject><subject>Young Adult</subject><issn>0149-2918</issn><issn>1879-114X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNks-KFDEQxoMo7jj6ChoQvc1Y6U4nnYuwDOoKCx5U8BbSSTWbsTs9JmllHsm3NM0Ms7AnTyGp31d_8hUhrxhsGTDxbr-1gw_5DqPZVgBqC_UWWP2IrFgr1YYx_uMxWQHjalMp1l6RZyntAaBWTfWUXDFVq7ptxIr8vUEz5DuKdgrT6C2103gw0acp0A7zH8RQnkL2YZ7mRNPc2TmbgMvFhzSXLsrZz8kXgQmOjvOQ_WFA6owfjiW2R5tLMNGpvyj6KdLSPM0RTR4x5CVoXJHSfDwgZdR5U8rjUoTuTDDOPCdPejMkfHE-1-T7xw_fdjeb2y-fPu-ubzeWt1XedKaxqgPVMWssl70QspFSgJLYd60QAB3vWgmNQcd7y4ELaCR3rnN903Jer8nbU95DnH7NmLIefbI4DKeptZBMMiFFAV8_APfTHEPpTTOoayagKpasiTxRNk4pRez1IfrRxGOB9OKl3uuLl3rxUkOti7AoX57zz92I7l53Nq8Ab86ASdYMfTTB-nThKsZZU_wu3PWJw_Jtvz1GnazHYNH5WMzRbvL_0cz7BzkWzpeyP_GI6X5ynSoN-uuyesvmgSpb17ZN_Q_qA9oJ</recordid><startdate>20090301</startdate><enddate>20090301</enddate><creator>Charles, Meaghan E.St., PhD</creator><creator>Sadri, Hamid, PharmD, MSc</creator><creator>Minshall, Michael E., MPH</creator><creator>Tunis, Sandra L., PhD</creator><general>EM Inc USA</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20090301</creationdate><title>Health economic comparison between continuous subcutaneous insulin infusion and multiple daily injections of insulin for the treatment of adult type 1 diabetes in Canada</title><author>Charles, Meaghan E.St., PhD ; Sadri, Hamid, PharmD, MSc ; Minshall, Michael E., MPH ; Tunis, Sandra L., PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c482t-ba5c9b09b1cac47f6675776097efb86600b4b8705aed4fc40460574ddbdf58443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>Canada</topic><topic>Computer Simulation</topic><topic>continuous subcutaneous insulin infusion</topic><topic>Cost analysis</topic><topic>Cost-Benefit Analysis</topic><topic>cost-effective</topic><topic>Diabetes</topic><topic>Diabetes Complications - economics</topic><topic>Diabetes Complications - therapy</topic><topic>Diabetes Mellitus, Type 1 - blood</topic><topic>Diabetes Mellitus, Type 1 - drug therapy</topic><topic>Diabetes Mellitus, Type 1 - economics</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Drug Administration Schedule</topic><topic>Drug Costs</topic><topic>Economic models</topic><topic>Economics</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Female</topic><topic>Financing, Government</topic><topic>Glycated Hemoglobin A - metabolism</topic><topic>Health Care Costs</topic><topic>Humans</topic><topic>Hypoglycemia</topic><topic>Hypoglycemic Agents - administration & dosage</topic><topic>Hypoglycemic Agents - economics</topic><topic>Infusion pumps</topic><topic>Injections, Subcutaneous</topic><topic>Insulin</topic><topic>Insulin - administration & dosage</topic><topic>Insulin - economics</topic><topic>Insulin Infusion Systems - economics</topic><topic>Internal Medicine</topic><topic>Life Expectancy</topic><topic>Male</topic><topic>Markov Chains</topic><topic>Medical Education</topic><topic>Medical sciences</topic><topic>modeling</topic><topic>Models, Economic</topic><topic>Monte Carlo simulation</topic><topic>multiple daily injections</topic><topic>Pharmacology. Drug treatments</topic><topic>Quality of life</topic><topic>Quality-Adjusted Life Years</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>type 1 diabetes mellitus</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Charles, Meaghan E.St., PhD</creatorcontrib><creatorcontrib>Sadri, Hamid, PharmD, MSc</creatorcontrib><creatorcontrib>Minshall, Michael E., MPH</creatorcontrib><creatorcontrib>Tunis, Sandra L., PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing & Allied Health Database</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database (Proquest)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Charles, Meaghan E.St., PhD</au><au>Sadri, Hamid, PharmD, MSc</au><au>Minshall, Michael E., MPH</au><au>Tunis, Sandra L., PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Health economic comparison between continuous subcutaneous insulin infusion and multiple daily injections of insulin for the treatment of adult type 1 diabetes in Canada</atitle><jtitle>Clinical therapeutics</jtitle><addtitle>Clin Ther</addtitle><date>2009-03-01</date><risdate>2009</risdate><volume>31</volume><issue>3</issue><spage>657</spage><epage>667</epage><pages>657-667</pages><issn>0149-2918</issn><eissn>1879-114X</eissn><abstract>Abstract Background: Patients with type 1 diabetes mellitus (DM) may be treated with insulin via multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). Objective: The purpose of this study was to evaluate the projected long-term cost-effectiveness of CSII compared with MDI by modeling a simulated sample of adult patients with type 1 DM in Canada. Methods: A health economic model was used to determine the incremental cost-effectiveness ratio (ICER) of CSII compared with MDI from the perspective of a Canadian provincial government. The primary input variable was change in glycosylated hemoglobin (HbA1c ). A series of Markov constructs also simulated the progression of disease-related complications. Annual acquisition costs for CSII and MDI were year-2006 Can $6347.18 and Can $4649.69, respectively. A 60-year time horizon and a discount rate of 5.0% per annum on costs and clinical outcomes were used. Results: Mean direct lifetime costs were Can $15,591 higher with CSII treatment than MDI. Treatment with CSII was associated with an improvement in discounted life expectancy of 0.655 quality-adjusted life-years (QALYs) over a 60-year time horizon, compared with MDI (mean [SD], 10.029 [0.133] vs 9.374 [0.076] QALYs). ICERs were Can $27,264 per life-year gained and Can $23,797 per QALY for CSII compared with MDI. The results were most sensitive to HbA1c assumptions. Conclusion: Based on this analysis, CSII may be a cost-effective treatment option when compared with MDI in adult patients with type 1 DM in Canada.</abstract><cop>Bridgewater, NJ</cop><pub>EM Inc USA</pub><pmid>19393856</pmid><doi>10.1016/j.clinthera.2009.03.013</doi><tpages>11</tpages></addata></record> |
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| ispartof | Clinical therapeutics, 2009-03, Vol.31 (3), p.657-667 |
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| subjects | Adult Biological and medical sciences Biomarkers - blood Canada Computer Simulation continuous subcutaneous insulin infusion Cost analysis Cost-Benefit Analysis cost-effective Diabetes Diabetes Complications - economics Diabetes Complications - therapy Diabetes Mellitus, Type 1 - blood Diabetes Mellitus, Type 1 - drug therapy Diabetes Mellitus, Type 1 - economics Diabetes. Impaired glucose tolerance Drug Administration Schedule Drug Costs Economic models Economics Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Female Financing, Government Glycated Hemoglobin A - metabolism Health Care Costs Humans Hypoglycemia Hypoglycemic Agents - administration & dosage Hypoglycemic Agents - economics Infusion pumps Injections, Subcutaneous Insulin Insulin - administration & dosage Insulin - economics Insulin Infusion Systems - economics Internal Medicine Life Expectancy Male Markov Chains Medical Education Medical sciences modeling Models, Economic Monte Carlo simulation multiple daily injections Pharmacology. Drug treatments Quality of life Quality-Adjusted Life Years Time Factors Treatment Outcome type 1 diabetes mellitus Young Adult |
| title | Health economic comparison between continuous subcutaneous insulin infusion and multiple daily injections of insulin for the treatment of adult type 1 diabetes in Canada |
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