The level of HbA1c at baseline affected the differences in average annual cost between study groups: the smallest difference ($2,300) was observed for individuals with HbA1c ≥8.6% (≥70 mmol/mol) and the greatest difference for individuals with HbA1c 6.5–8.5% (48–69 mmol/mol) at baseline. Swedish National Diabetes Register. The first kind is a traditional insulin pump. 2019; 365: l1226; doi: 10.1136/bmj.l1226[OpenUrl][1][Abstract/FREE Full Text][2] Investigators from multiple institutions in the United Kingdom conducted a randomized trial to compare the efficacy and costs of using continuous subcutaneous insulin infusion (CSII) or multiple daily injection (MDI) insulin regimens for the treatment of children with newly diagnosed type 1 diabetes. Cost & Reputed Branded Insulin Pump. The researchers found that annual costs for adults who used insulin pump therapy were $3,923 more than those who used multiple daily injections (95% CI, 3,703-4,143). Equipment costs include the glucose meters and consumables (lancets and test strips), insulin pens and consumables (needles), and insulin pumps and consumables (batteries, and infusion sets). The higher annual costs observed in the main analysis were driven by more health care resource use and loss of production in the broadest population, while cohort D2 included only very regular individuals with complete observations. and K.S.C. Similarly, with a threshold of $100,000, the required gain in annual QALYs would have to be between 0.03 and 0.06. With the use of time-varying propensity scores, we allowed selected MDI control subjects to switch to pump therapy rather than to condition their eligibility or noneligibility on a future therapeutic change. Here’s how it works. The smaller difference was driven by lower health care costs and production loss in the pump group. Use of real-world data implied imperfect entry over time for treatment and missing data among the clinical variables in the NDR. This large nationwide study of 4,991 individuals with type 1 diabetes and insulin pump therapy and 9,247 propensity score–matched control subjects with MDI treatment showed higher annual total costs for pump therapy (∼$3,900). The univariate analysis of mean values used the t test for differences between the therapy groups on the basis of the central limit theorem, guaranteeing near normality of sample means (11). Health care costs, including medications and disposables, accounted for 73% of the costs for pump therapy and 63% of the costs for MDI therapy. Analyses of the number of health care events related to specific complications defined by the main diagnosis showed limited need overall in terms of events per 1,000 person-years (Supplementary Table 5). Here’s how it works. The pump acquisition cost was amortized over 5 years. Mean annual costs in 2005–2013 for people with type 1 diabetes on insulin pump or MDI therapy by subgroup. A relevant research question from a health care planning perspective is whether real-world data match earlier model-based predictions for differences in resource use and costs. Registration of insulin pump therapy started in 2002 in the NDR, and use of pump therapy among individuals with type 1 diabetes increased from 10% in 2002 to 22% in 2015 (6). Nurs Manage. Talk to your health care provider about your diabetes management plan, including diet and exercise. Supplementary Figure 2A–C shows the distribution of age, diabetes duration, and HbA1c level at baseline (index date). The costs of insulin were calculated by two methods: insulin dispensed and insulin used. Whether or not we use an insulin pump or MDI, we all need to adjust our rapid-acting insulin if we want to exercise or move around without going low. Insulin pump costs The cost of insulin pumps is often between £2000 and £3000. Using the often high within-patient correlation in clinical and socioeconomic data between years, missing data were imputed in three steps starting with the 1) last value carried forward, 2) first value carried backward, and 3) single stochastic imputation on the basis of a multivariate normal distribution. A total of 35,921 individuals with type 1 diabetes had at least one entry in 2002–2012 and were eligible for this study. For each individual with insulin pump therapy, we matched two control subjects and allowed treatment switches from MDI to insulin pump. This is very difficult to answer straight off the bat, because this is a highly individual topic. Objectives To assess the long-term cost-effectiveness of insulin pumps and Dose Adjustment for Normal Eating (pumps+DAFNE) compared with multiple daily insulin injections and DAFNE (MDI+DAFNE) for adults with type 1 diabetes mellitus (T1DM) in the UK. Including unemployment benefits, a small difference was found in total production loss, with higher costs in the pump users (P = 0.041). This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc18-1850/-/DC1. Health care events were categorized using ICD-10 on the basis of the main diagnosis entered for the appointment (Supplementary Table 1). We performed 13 subgroup analyses to evaluate the robustness of the estimates of level of costs and differences between treatment groups. These data reflect real-world clinical decision making and use of insulin pump therapy in 2005–2013. Insulin via subcutaneous injection delivers insulin … Therefore, it is important for pharmacists to consider the clinical and economic implications of the decision between insulin pens and insulin vials and syringes. If the payer’s cost-effectiveness threshold is $50,000 per QALY gained, treatment needs to provide an average annual additional 0.1 QALY or, on the basis of the subgroup analyses, gains in the range of 0.06–0.12 QALY. Also, being attached to the pump via tubing or pod is a 24/7 thing and for some this makes a pump a constant reminder of diabetes. The Supplementary Data presents additional panel data regressions on the risk of at least some inpatient care, sickness episodes, and use of unemployment benefits. This allows patients to avoid multiple needle pricks and insulin injections each day. At baseline, the proportion of previous cardiovascular disease in the NDR study (5) was 5% versus 8% of the pump versus MDI groups, respectively, whereas it was ∼2.5% in both groups of the current study. Funding. Association Of Insulin Pump Therapy Vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, And Glycemic Control Among Children, Adolescents, And Young Adults With Type 1 Diabetes. The cost of insulin pumps is often between £2000 and £3000. BMJ. A lack of comparable calculations of total costs of diabetes treatment has been published to date, but cost-effectiveness studies of pump and MDI therapy have predicted long-term costs for the two treatment methods. Of the total cohort, 4,991 used insulin pump therapy (mean age, 33.8 years; 51.1% women). Certain medical supplies used to inject insulin, like syringes, gauze, and alcohol swabs; However, if you use an external insulin pump, insulin and the pump may be covered as durable medical equipment (DME) under Part B. Data from the Swedish National Diabetes Register (NDR) have shown a lower incidence of some cardiovascular events and all-cause mortality for individuals with type 1 diabetes on insulin pump therapy in 2005–2012 (5). Mean annual costs were analyzed using univariate analysis. Now, with the pump, it’s one injection every 3 days. Sensitivity analyses were used to explore two alternative definitions of continuous insulin pump therapy (liberal = 1, strict = 2) and four strategies (A–D) for imputing missing variable information (last value carried forward, first value carried backward, model-based single imputation, no imputation), which generated eight different and overlapping cohorts (A1–D2) (Supplementary Table 3). Author Contributions. With the use of propensity score matching, a real-world study of German-Austrian registry data (age up to 20 years) on type 1 diabetes found lower rates of severe hypoglycemia and diabetic ketoacidosis associated with pump therapy than with MDI and for the unmatched entire cohort (14). Thank you for your interest in spreading the word about Diabetes Care. The DRG code was linked with the corresponding yearly DRG weight (Swedish National Board of Health and Welfare [8,9]). Type 1 diabetes is defined as treatment with insulin and diagnosis at age 30 years or younger. 20 Years of Successful Improvements. Get the latest news and education delivered to your inbox, Receive an email when new articles are posted on, Please provide your email address to receive an email when new articles are posted on, Tell us what you think about Healio.com. The main findings included a lower adjusted hazard ratio of fatal coronary heart disease and fatal cardiovascular disease as well as lower all-cause mortality. This might be beneficial for some, but a psychological downer for others. With an insulin pump, it’s harder to hide. The costs of production loss were somewhat underestimated. Pump users also spent more annually on medication costs, including disposables ($5,861; 95% CI, 5,814-5,907), than multiple daily injection users ($2,285; 95% CI, 2,270-2,300). A study from the NDR investigated the association between insulin pump therapy and cardiovascular disease (5). reports personal fees from Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Mundipharma, Navamedic, Novo Nordisk, Sanofi, and RLS Global and unrestricted research support from Sanofi, all outside the submitted work. 4) Expense With pumps, cost is surely a consideration. Most people in the UK who have a pump have it funded by the NHS. © 2021 by the American Diabetes Association. E.T.G. Cox proportional hazard functions were used to account for time-variant covariates in the matching equations and to model the time since last measurement for control subjects (7). A small difference was found in mean sickness benefits between the treatment groups but no significant difference in early retirement benefits. (2) performed a meta-review of model-based studies that compared pump therapy and MDI, concluding that pump therapy can be cost effective. Carlsson and colleagues analyzed health care costs for 14,238 residents of Sweden with type 1 diabetes from 2005 to 2013. DESIGN Pragmatic, multicentre, open label, parallel group, randomised controlled trial and economic evaluation. Gothenburg, Sweden, Centre of Registers Västra Götaland, 2016, Swedish National Board of Health and Welfare. Cost & Reputed Branded Insulin Pump. With tube insulin pumps cost less than tubeless or implanted pumps. AIMS: To estimate the cost effectiveness of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) for patients using insulin pumps. The second type of insulin pump is a patch pump. The main analysis used cohort A1, combining a liberal definition that allowed for single information gaps and the most extensive imputation strategy. The strength of this observational study is the size and completeness of the study population, with virtually all adults with type 1 diabetes in Sweden included, longitudinal national register data, and a matching technique that accounts for time-variant variables, including diabetes duration, diabetes-related conditions and comorbidities, and demographic and socioeconomic factors. Now, with the pump, it’s one injection every 3 days. Further description of the matching strategy is provided in the Supplementary Data. It really depends where you live! This pump uses a tube to connect the pump to the cannula. Identification of tangible and intangible patient benefits from insulin pump therapy over time remain important to the valuation of technology and support of resource allocation decisions. “Whether insulin pump therapy is cost-efficient, ultimately, depends on therapeutic effects beyond resource use and costs as well as on how much the payer is prepared to invest in additional quality-adjusted life-years,” the researchers wrote. Abstract Importance: Insulin pump therapy may improve metabolic control in young patients with type 1 diabetes, but the association with short-term diabetes complications is unclear. Consequently, the route of administration for insulin can be by injection, including syringe or single-dose pen, or by intravenous pump. Pump users had more outpatient appointments (3.8 vs. 3.5 per year; P < 0.001) and were less likely to have person-years without use of outpatient or inpatient care (9% vs. 12% of person-years). A systematic review of cost-effectiveness studies summarized comparisons of insulin pump and MDI therapy using model analyses to describe the expected impact on long-term costs, development of complications, and quality of life (2). Supplementary Fig. Extended bolus. Roze et al. The current data represent real-world use of insulin pumps in 2005–2013, with significant proportions of young adults and other individuals who had <20 years of diabetes duration. The hormone that controls blood sugar among diabetics is one of the oldest medicines used today. Cost of medications and disposables by Swedish pharmacy official retail prices were taken from the Swedish Prescribed Drug Register. Table 2 shows univariate estimates of mean annual resource use and costs by type, and Supplementary Table 4 presents median statistics. We understand that trying to get an insulin pump can be very frustrating, and you might feel disappointed if you can’t get one. 2016-5-9) [in Swedish], Statistics Sweden (Ed.). Overall inpatient costs were higher for pump users ($1,972; 95% CI, 1.864-2,081) compared with multiple daily injection users ($1,897; 95% CI, 1,826-1,968), specifically in relation to inpatient services for diabetes complications (P < .012). Subgroup analysis revealed that health care costs, both for pump therapy and multiple daily injections, were higher for women compared with men (P < .001), adults aged at least 48 years compared with younger adults (P < .001) and those with diabetes duration of 20 years or more compared with shorter duration (P < .001). 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