Cost-effectiveness of sensor-augmented pump therapy in adults with type 1 diabetes in the United States.

Published

Journal Article

OBJECTIVES: A recent randomized trial demonstrated significant reductions in hemoglobin A(1c) levels with sensor-augmented pump therapy (SAPT) compared with multiple daily injections of insulin (MDI) in type 1 diabetes. We analyzed resource use in the trial and estimated the long-term cost-effectiveness of SAPT from the perspective of the US health care system. METHODS: We undertook a cost-effectiveness analysis combining estimates from the trial and the literature to populate the previously validated Center for Outcomes Research (CORE) Diabetes Model. Results represent the use of 3-day sensors, as in the trial, and 6-day sensors, approved in most markets but not yet approved in the United States. RESULTS: Within-trial hospital days, emergency department visits, and outpatient visits did not differ significantly between the treatment groups. Assuming 65% use of 3-day sensors, treatment-related costs in year 1 were an estimated $10,760 for SAPT and $5072 for MDI. Discounted lifetime estimates were $253,493 in direct medical costs and 10.794 quality-adjusted life-years (QALYs) for SAPT and $167,170 in direct medical costs and 10.418 QALYs for MDI. For 3-day and 6-day sensors, the incremental cost-effectiveness ratios were $229,675 per QALY (95% confidence interval $139,071-$720,865) and $168,104 per QALY (95% confidence interval $102,819-$523,161), respectively. The ratios ranged from $69,837 to $211,113 per QALY with different strategies for incorporating utility benefits resulting from less fear of hypoglycemia with SAPT. CONCLUSION: Despite superior clinical benefits of SAPT compared with MDI, SAPT does not appear to be economically attractive in the United States for adults with type 1 diabetes in its current state of development. However, further clinical developments reducing disposable costs of the system could significantly improve its economic attractiveness.

Full Text

Duke Authors

Cited Authors

  • Kamble, S; Schulman, KA; Reed, SD

Published Date

  • July 2012

Published In

Volume / Issue

  • 15 / 5

Start / End Page

  • 632 - 638

PubMed ID

  • 22867771

Pubmed Central ID

  • 22867771

Electronic International Standard Serial Number (EISSN)

  • 1524-4733

Digital Object Identifier (DOI)

  • 10.1016/j.jval.2012.02.011

Language

  • eng

Conference Location

  • United States