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Insulin pump therapy more costly than daily injections in type 1 diabetes

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February 13, 2019

Health care costs are higher for Swedish adults with type 1 diabetes who use insulin pump therapy compared with those who use multiple daily injections, according to findings published in Diabetes Care.

“In principle, optimal glycemic control may be achieved by either [multiple daily injection] or insulin pump therapy,” Katarina Steen Carlsson, PhD, of the department of clinical sciences at University in Sweden, and colleagues wrote. “In practice, where individuals with type 1 diabetes face challenges of the disease in daily management, the two modes of insulin administration could differ in effectiveness, ease of use and association with adverse events, and, therefore, be associated with differences in patient outcomes.”

Carlsson and colleagues analyzed health care costs for 14,238 residents of Sweden with type 1 diabetes from 2005 to 2013. Of the total cohort, 4,991 used insulin pump therapy (mean age, 33.8 years; 51.1% women). Insulin pump therapy users were double-matched to 9,247 adults who used multiple injection therapy (mean age, 33.8 years; 51.3% women). Data about diabetes diagnosis and insulin treatment regimens were obtained from the Swedish National Diabetes Register. Longitudinal health and socioeconomic data were collected from the National Patient Register, National Prescribed Drug Register, National Cause of Death Register and National Integrated Database for Labor Market Research.

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). There were also more annual outpatient visits among pump users compared with multiple daily injection users (3.8 vs. 3.5; P < .001). Pump users had higher average costs for outpatient treatment ($1,665; 95% CI, 1,615-1,714) compared with multiple daily injection users ($1,507; 95% CI, 1,473-1,542). 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). 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).

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). In addition, higher HbA1c levels at enrollment in the Swedish National Diabetes Register were associated with increased costs (P <.001), as was starting therapy at age 18 years or older compared with younger (P < .001).

“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. “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

Disclosures: Carlsson reports she is an employee of the Swedish Institute for Health Economics. Please see the study for all other authors’ relevant financial disclosures.

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