Health-Economic Comparison of Sensor-Augmented Pump With Low Glucose Suspend Versus Insulin Pump Alone For The Treatment Of Hypo-Prone Type 1 Diabetes In Slovakia.

Abstract

To project the long-term costs and outcomes of sensor-augmented pump (SAP) with low glucose suspend (LGS) versus insulin pump alone (CSII) for the treatment of hypo-prone Type 1 diabetes in Slovakia. The CORE Diabetes Model is a peer-reviewed, validated model, which employs standard Markov/Monte Carlo simulation techniques to describe the long-term incidence and progression of diabetes-related complications. It was used to simulate disease progression in a cohort of patients with baseline characteristics (mean age 18.6 years, duration of diabetes 12 years, mean HbA1c 7.5%) and clinical outcomes (severe hypoglycaemic event rates; Quality of Life; HbA1c) taken from a recent randomised controlled trial (Ly et al, 2013). Local treatment and complication cost data was used. The main scenario considered in this cost-effectiveness analysis was the comparison of sensor-augmented insulin pump (SAP) with low glucose suspend (LGS) versus insulin pump alone (CSII). The target population was type I hypo-prone diabetes patients with the analysis based on a deterministic microsimulation of 1,000 patients, using a 5 year time horizon. Direct costs were calculated from a third-party payer perspective. Discount rates of 3% per annum were applied to both costs and clinical outcomes. The Incremental-Cost-Effectiveness-Ratio (ICER) for SAP+LGS (vs CSII) was €17,893 per Quality-Adjusted-Life-Year gained over a 5 year time horizon. Results were similar across a 1 to 10 year time horizon. Other extensive sensitivity analyses showed the robustness of the results. Using a payer’s perspective, our analysis showed that SAP (w LGS) is cost-effective over a short term (5 year) time horizon in hypo-prone Type 1 Diabetes patients in Slovakia (using a WTP threshold of 1x [€18,000] or 3x [€54,000] Slovakia GDP).