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. 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). The difference in annual costs between the main analysis and the subgroup analyses was more pronounced for individuals with MDI versus pump therapy. 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. Therefore there should be no economical hindrance for the patient to be treated with insulin pump. 2. E.T.G. and A.-M.S. Individuals were included in the analyses up to 31 December 2012, and each observation was followed until 31 December 2013 for all outcomes. This might be beneficial for some, but a psychological downer for others. The number of events related to kidney disease was driven by a few individuals with manifest kidney disease and frequent appointments. The account is genuine, typical and documented. Cost & Reputed Branded Insulin Pump. Data on sickness benefits, unemployment benefits, and early retirement benefits were taken from the National Integrated Database for Labor Market Research (10). DRG Statistics 2014—A Description of Healthcare Consumption in Sweden. With an insulin pump, it’s harder to hide. Control subjects on MDI were matched 2:1 using time-varying propensity scores. 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. Pumps are recommended for children under 12 when multiple daily insulin injections aren’t practical or appropriate. The largest cost difference was found for individuals with middle HbA1c levels (6.5–8.5% [48–69 mmol/mol], pump $12,824 vs. MDI $8,083; P < 0.001). According to the same website, the average insulin pump price, is expensive and some patients cannot afford it, not without the help of their insurance coverage. Annual resource use and annual costs in 2005–2013 for individuals with type 1 diabetes on insulin pump or MDI therapy. We used diagnosis-related group (DRG) codes and the main diagnosis to assign costs to inpatient and outpatient specialist appointments. For each individual with insulin pump therapy, we matched two control subjects and allowed treatment switches from MDI to insulin pump. Subgroup analyses by age indicated that the value of improved prevention may take time to manifest. With tube insulin pumps cost less than tubeless or implanted pumps. Acknowledgments. If you have an insulin pump on the NHS , you may need to cover some of the costs which may include insurance, accessories and, in the case of some pumps, glucose sensors as well. The remaining study years, including the year of switch, contributed to the insulin pump group for this individual. The difference in research questions between this study and the NDR study required alternative estimation methods. AIMS: To estimate the cost effectiveness of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) for patients using insulin pumps. This allows patients to avoid multiple needle pricks and insulin injections each day. Diabetes Care. Insulin therapy is crucial to the treatment of many patients with diabetes mellitus. Continuous subcutaneous insulin infusion, or insulin pump, therapy for individuals with type 1 diabetes has increased gradually since the 1980s. Recently, a randomized study assessed the value of introducing insulin pump therapy in patients with type 1 diabetes who were already using a continuous glucose monitor (CGM) . Years for which individuals had no available data in population registers, for instance, because of migration, were excluded together with those of matched control subjects, unless the control subject had switched to pump therapy and thus had been censored as a control. Benefits of insulin pumps Insulin pumps: Cannulas are put into the skin every few days Injections: Injections are needed […] Multiple Daily Injections vs Insulin Pumps Some people with type 1 diabetes will be offered the choice of staying on multiple daily injections or starting on an insulin pump. Before I was on the pump I would give about 10 injections a day (including my long-acting insulin). 1A and B). With an insulin pump, it’s harder to hide. 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). Mean cost for women and individuals starting insulin pump therapy while entered in the NDR were slightly higher, but the difference was lower between treatment groups than in the main analysis. 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). Author Contributions. METHODS: We constructed a Markov model to estimate the costs and outcomes for patients with insulin-dependent diabetes (IDDM) treated with CSII using an insulin pump compared with MDI. Mean annual costs in 2005–2013 for people with type 1 diabetes on insulin pump or MDI therapy by subgroup. The difference in the annual total cost between the therapy groups was $3,923 (95% CI $3,703–$4,143). Neither has received payment outside of normal salary related to the subject matter of this work. Available from, Swedish National Board of Health and Welfare (Ed.). These data reflect real-world clinical decision making and use of insulin pump therapy in 2005–2013. “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.” – by Phil Neuffer. This study followed 345 young people on pump therapy over the course of seven years, matching them to controls using insulin injections. 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 No other potential conflicts of interest relevant to this article were reported. 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. AIMS: To estimate the cost effectiveness of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) for patients using insulin pumps. The Swedish Diabetes Association and the Swedish Society of Diabetology support the NDR. 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. The previous study investigated the relative risks of complications on the basis of time to the first event, whereas the current study summarized costs of all events of complications and regular health care use, medications, and production loss, given that all contribute to total annual costs. Objective: To investigate real-world costs of continuous insulin pump therapy compared with multiple daily injection (MDI) therapy for type 1 diabetes. Pediatr Diabetes 2008; 9 (4pt1): 291-6. doi: 10.1111/j.1399-5448.2008.00396.x pmid: 18466210 The first kind is a traditional insulin pump. No worrying. Production loss was approximated as the sum of sickness benefit, early retirement benefits, and unemployment benefits. Now, with the pump, it’s one injection every 3 days. Periods of sick leave <14 days are not included in national registers, and some of the workforce may not yet be eligible for unemployment benefits (e.g., young people with short contracts). 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. With tube insulin pumps cost around $4000-$5000 each, while tubeless pumps cost around $6000-$7000 each. Supplementary Table 7 shows results by three alternative model specifications. A small difference was found in mean sickness benefits between the treatment groups but no significant difference in early retirement benefits. Admissions for diabetic ketoacidosis were lower in the insulin-pump group than in the insulin-injection group -- 2.3 and 4.7 per 100 patients per year, respectively, according to the study. However, only 70% of individuals with pump therapy could be matched, and baseline characteristics indicated high standardized differences in age, diabetes duration, and HbA1c between treatment groups in the entire cohort. This pump uses a tube to connect the pump to the cannula. The Swedish National Diabetes Register. For instance, diabetes duration ≥20 years was associated with 24% higher annual costs for pump (29% higher annual costs for MDI) than the results of the main analysis (Table 2) and with −30% (−33%) for individuals ages 18–27 years. The difference in annual medication costs, including disposables, was $3,600, indicating that they contributed significantly to overall annual cost differences. In three cases, pump users had fewer events (peripheral vascular disease [P = 0.004]) and, with borderline significance, fewer events of angina pectoris (P = 0.052) and liver disease (P = 0.057). No tedious technical management. Therefore, it is important for pharmacists to consider the clinical and economic implications of the decision between insulin pens and insulin vials and syringes. Previous model-based cost-effectiveness analyses have reported expected discounted QALY gains for a lifetime in the range of 0.46–1.06 QALYs, whereas the estimates of the increase in discounted lifetime costs varied (2). NICE guidance in 2008 records the following costs of insulin pumps: The risk for unmarried individuals was higher and showed an inverted U shape for age and education, with the highest risk for those 28–37 years old and for those with 10–12 years of education. Five of the studies reported long-term discounted incremental costs of insulin pumps of $20,000–$40,000, whereas two studies reported lower and one higher additional costs for insulin pump therapy. BMJ. If that were the case, the incidence of diabetic complications would not differ between the two treatment alternatives, at least not those associated with maintaining adequate glycemic control. Thank you for your interest in spreading the word about Diabetes Care. are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The corresponding cost for a 40-year time horizon is $95,000. CBS News quotes a college student saying her bill for insulin has risen from $130 to $495 per month. Socioeconomic and demographic factors associated with annual cost, 2005–2013. All costs are indexed to 2013 values. Costs in dollars were calculated using $1 = 6.514 SEK (annual exchange rate for 2013 from the Swedish Central Bank). No worrying. 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. Objective: To investigate real-world costs of continuous insulin pump therapy compared with multiple daily injection (MDI) therapy for type 1 diabetes. The DRG code was linked with the corresponding yearly DRG weight (Swedish National Board of Health and Welfare [8,9]). A.-M.S. The overall incidence rate of first events with cardiovascular disease for this study cohort was 9 per 1,000 person-years, whereas the corresponding figure for the previous study was 12.5 per 1,000 person-years. developed the study concept and design, interpreted data, and critically revised and completed the manuscript. The NDR includes ∼97% of all Swedish individuals with type 1 diabetes age 18 years and older. Observational studies provide a better indication of what is achieved in daily medical practice than randomized controlled studies (12). 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. This pump uses a tube to connect the pump to the cannula. Similarly, with a threshold of $100,000, the required gain in annual QALYs would have to be between 0.03 and 0.06. The study cohort was younger than the average individual with type 1 diabetes in the NDR (34 vs. 46 years), had a shorter duration of diabetes (21 vs. 24 years), and had a higher HbA1c (8.1 vs. 7.8% [65 vs. 62 mmol/mol]) at baseline. The cost of insulin pumps is often between £2000 and £3000. Insulin pump therapy users were double-matched to 9,247 adults who used multiple injection therapy (mean age, 33.8 years; 51.3% women). Supplementary Figure 2A–C shows the distribution of age, diabetes duration, and HbA1c level at baseline (index date). While there are many different insulin pumps available on the market, there are typically two kinds of pumps you can get. Health care costs, including medications and disposables, accounted for 73% of the costs for pump therapy and 63% of the costs for MDI therapy. Our national real-world longitudinal data show additional costs for insulin pump therapy. We obtained longitudinal health and socioeconomic data for 2005–2013 from the National Patient Register, National Prescribed Drug Register, National Cause of Death Register, and National Integrated Database for Labor Market Research. Swedish National Diabetes Register. performed the statistical and economic analyses and drafted the manuscript. 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. Funding. Stockholm, Sweden, Statens beredning för medicinsk och social utvärdering, 2013 (publication no. Now, with the pump, it’s one injection every 3 days. Objectives: To compare glucose profiles in patients with T1DM who use continuous subcutaneous insulin infusion (CSII) compared with those who use multiple daily injections (MDI) insulin regimen during Ramadan fast. The Supplementary Data further describes the costing strategy and variables (Supplementary Table 2). The main study variables were number of inpatient and outpatient events; costs of inpatient care, outpatient care, medication, and disposables; sickness benefit, early retirement benefits, and unemployment benefits; and all data summarized annually. But more than 90 years after its discovery, a low-cost version is no longer available in the U.S. 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). Each method of administering insulin has advantages and disadvantages. With tube insulin pumps cost around $4000-$5000 each, while tubeless pumps cost around $6000-$7000 each. All prices are at the 2013 level, using the Consumer Price Index to adjust costs of medications, disposables, and income and the Län (County) Price Index to adjust prices of appointments. 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. 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). DESIGN Pragmatic, multicentre, open label, parallel group, randomised controlled trial and economic evaluation. 1 shows a flowchart of study inclusion and exclusion. But more than 90 years after its discovery, a low-cost version is no longer available in the U.S. Total costs were higher for women but decreased with years of education and disposable income. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548. Overall, we found similar results for both study groups in terms of health care resource use other than medications and disposables. However, cost differences between the study groups of the sensitivity analyses were stable at ∼$4,000 (range $3,600–$4,600). Relevance: Blair, et al. 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). We found lower rates of events in our adult population than the German-Austrian study (14). Regression analyses showed higher costs for low education, low disposable income, women, and older age. Use of real-world data implied imperfect entry over time for treatment and missing data among the clinical variables in the NDR. 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). 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