Tim Jones
In patients with type 1 diabetes who lack awareness of hypoglycaemia, the objective was to compare the cost-effectiveness of sensor-augmented insulin pump therapy with "Low Glucose Suspend" (LGS) functionality to standard pump therapy with self-monitoring of blood glucose.
Methods: The net costs and effectiveness of the two treatment options were calculated and expressed as an incremental cost-effectiveness ratio (ICER) in an economic evaluation based on a clinical trial. The rate of severe hypoglycaemia in each LGS study arm was the clinical outcome of interest for the evaluation. Personal satisfaction utility scores were determined utilizing the three-level EuroQol five-layered survey. Costs associated with resource use were estimated using public data.
Results: At six months, compared to standard pump therapy, the use of sensor-augmented insulin pump therapy with LGS significantly reduced the incidence of severe hypoglycaemia (incident rate difference 1.85 [0.17–3.53]); P = 0.037). The ICER per severe hypoglycaemic event avoided was $18,257 for all patients in a primary randomized study and $14,944 for patients over the age of 12. The ICERs were $17,602 and $14,289, respectively, when all major medical resource costs (like hospital admissions) were taken into account. For patients over the age of 12, the cost per quality-adjusted life-year gained over the course of the six months was $40,803.
Conclusions: In type 1 diabetes patients who are unaware of their hypoglycaemia, sensor-augmented insulin pump therapy with LGS may be considered a cost-effective alternative to standard pump therapy with selfmonitoring of blood glucose. This is based on the Australian experience evaluating new interventions across a wide range of therapeutic areas.
KeywordsCost-effectiveness; Hypoglycaemia; Insulin pump therapy; Type 1 diabetes