Trang T Ly1, Alan J M Brnabic2, Andrew Eggleston3, Athena Kolivos3, Margaret E McBride3, Rudolf Schrover4, Timothy W Jones5. 1. Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia; Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia; School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia. 2. OPTUM, Asia Pacific Life Sciences, Lilyfield, NSW, Australia. 3. Medtronic Australasia, North Ryde, NSW, Australia. 4. PRIMA Consulting Group Pty Ltd, Chatswood, NSW, Australia. 5. Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia; Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia; School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia. Electronic address: tim.jones@health.wa.gov.au.
Abstract
OBJECTIVE: To assess the cost-effectiveness of sensor-augmented insulin pump therapy with "Low Glucose Suspend" (LGS) functionality versus standard pump therapy with self-monitoring of blood glucose in patients with type 1 diabetes who have impaired awareness of hypoglycemia. METHODS: A clinical trial-based economic evaluation was performed in which the net costs and effectiveness of the two treatment modalities were calculated and expressed as an incremental cost-effectiveness ratio (ICER). The clinical outcome of interest for the evaluation was the rate of severe hypoglycemia in each arm of the LGS study. Quality-of-life utility scores were calculated using the three-level EuroQol five-dimensional questionnaire. Resource use costs were estimated using public sources. RESULTS: After 6 months, the use of sensor-augmented insulin pump therapy with LGS significantly reduced the incidence of severe hypoglycemia compared with standard pump therapy (incident rate difference 1.85 [0.17-3.53]; P = 0.037). Based on a primary randomized study, the ICER per severe hypoglycemic event avoided was $18,257 for all patients and $14,944 for those aged 12 years and older. Including all major medical resource costs (e.g., hospital admissions), the ICERs were $17,602 and $14,289, respectively. Over the 6-month period, the cost per quality-adjusted life-year gained was $40,803 for patients aged 12 years and older. CONCLUSIONS: Based on the Australian experience evaluating new interventions across a broad range of therapeutic areas, sensor-augmented insulin pump therapy with LGS may be considered a cost-effective alternative to standard pump therapy with self-monitoring of blood glucose in hypoglycemia unaware patients with type 1 diabetes.
RCT Entities:
OBJECTIVE: To assess the cost-effectiveness of sensor-augmented insulin pump therapy with "Low Glucose Suspend" (LGS) functionality versus standard pump therapy with self-monitoring of blood glucose in patients with type 1 diabetes who have impaired awareness of hypoglycemia. METHODS: A clinical trial-based economic evaluation was performed in which the net costs and effectiveness of the two treatment modalities were calculated and expressed as an incremental cost-effectiveness ratio (ICER). The clinical outcome of interest for the evaluation was the rate of severe hypoglycemia in each arm of the LGS study. Quality-of-life utility scores were calculated using the three-level EuroQol five-dimensional questionnaire. Resource use costs were estimated using public sources. RESULTS: After 6 months, the use of sensor-augmented insulin pump therapy with LGS significantly reduced the incidence of severe hypoglycemia compared with standard pump therapy (incident rate difference 1.85 [0.17-3.53]; P = 0.037). Based on a primary randomized study, the ICER per severe hypoglycemic event avoided was $18,257 for all patients and $14,944 for those aged 12 years and older. Including all major medical resource costs (e.g., hospital admissions), the ICERs were $17,602 and $14,289, respectively. Over the 6-month period, the cost per quality-adjusted life-year gained was $40,803 for patients aged 12 years and older. CONCLUSIONS: Based on the Australian experience evaluating new interventions across a broad range of therapeutic areas, sensor-augmented insulin pump therapy with LGS may be considered a cost-effective alternative to standard pump therapy with self-monitoring of blood glucose in hypoglycemia unaware patients with type 1 diabetes.
Authors: Thomas Danne; Revital Nimri; Tadej Battelino; Richard M Bergenstal; Kelly L Close; J Hans DeVries; Satish Garg; Lutz Heinemann; Irl Hirsch; Stephanie A Amiel; Roy Beck; Emanuele Bosi; Bruce Buckingham; Claudio Cobelli; Eyal Dassau; Francis J Doyle; Simon Heller; Roman Hovorka; Weiping Jia; Tim Jones; Olga Kordonouri; Boris Kovatchev; Aaron Kowalski; Lori Laffel; David Maahs; Helen R Murphy; Kirsten Nørgaard; Christopher G Parkin; Eric Renard; Banshi Saboo; Mauro Scharf; William V Tamborlane; Stuart A Weinzimer; Moshe Phillip Journal: Diabetes Care Date: 2017-12 Impact factor: 19.112