Cost-effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections of insulin in Type1 diabetes: a systematic review

AimContinuous subcutaneous insulin infusion (CSII) is increasingly used in clinical practice for the management of selected patients with Type1 diabetes. Several cost-effectiveness studies comparing CSII vs. multiple insulin injections (MDI) have been reported. The aim was systematically to review these analyses and test the hypothesis that CSII is a cost-effective use of healthcare resources across settings. MethodsA literature review was performed using MEDLINE, Cochrane Library and other databases. No time limit or language restrictions were applied. After two rounds of screening, 11 cost-effectiveness analyses were included in the final review, of which nine used the CORE Diabetes Model. A narrative synthesis was conducted and mean cost effectiveness calculated. ResultsCSII was considered cost-effective vs. MDI in Type1 diabetes in all 11 studies in 8 countries, with a mean (95% CI) incremental cost effectiveness ratio of Euro30862 (17997-43727), US$40143 (23409-56876) per quality-adjusted life year (QALY) gained. CSII was associated with improved life expectancy and quality-adjusted life expectancy (0.4-1.1 QALYs in adults), driven by lower HbA(1c) and lower frequency of hypoglycaemic events vs. MDI. CSII was associated with higher lifetime direct costs due to higher treatment costs but this was partially offset by cost-savings from reduced diabetes-related complications. ConclusionsPublished cost-effectiveness analyses show that in Type1 diabetes CSII is cost-effective vs. MDI across a number of settings for patients who have poor glycaemic control and/or problematic hypoglycaemia on MDI, with cost-effectiveness highly sensitive to the reduction in HbA(1c) and hypoglycaemia frequency associated with CSII.