PDB37 - BUDGET IMPACT ANALYSIS OF THE ADULT TYPE 1 DIABETES MELLITUS NATIONAL CLINICAL GUIDELINE IN IRELAND

Abstract

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease that arises following the destruction of insulin-producing beta cells in the pancreas. T1DM patients require insulin therapy to regulate their blood glucose levels and to avoid microvascular and macrovascular complications. The purpose of this analysis was to conduct a budget impact analysis (BIA) of the Adult type 1 diabetes mellitus (T1DM) national clinical guideline (NCG), published by the National Clinical Effectiveness Committee (NCEC) to standardise management and treatment of T1DM in Ireland. The BIA, which followed Irish national guidelines, adopted the national healthcare payer perspective over a five year time horizon with all costs reported in 2017 euros. Univariate sensitivity and scenario analyses were conducted to control for uncertainty in the model. Three key changes would result from implementation of the guideline: (1) expansion in provision of structured education programmes (SEPs); (2) provision of short education courses for healthcare professionals (HCPs) involved in the delivery of care to T1DM patients; and (3) standardisation of appointment frequency offered to T1DM patients in consultant-led outpatient diabetes clinics. The incremental cost of expanding SEPs, entailing the setup of 11 additional SEP centres, was €2.9 million after accounting for savings of €3.2 million from the prevention of adverse events due to poor hyperglycaemic control. An estimated 1,825 additional patients would receive SEP training at a cost per patient of €1,600. The estimated budget impact to provide short courses to HCPs was €18,000. The opportunity cost of providing 24,675 additional structured reviews to T1DM patients was €3.2 million. The most influential parameters in the BIA were staff recruitment costs, the opportunity cost of standardising appointment frequency and the assumed cost savings from the prevention of complications requiring hospital admission. Provision of SEPs may be cost-saving in the Irish setting in the long-term.