PDB63 COST-EFFECTIVENESS OF INSULIN PUMP AND CONTINUES GLUCOSE MONITORING VERSUS MULTIPLE DAILY INJECTIONS AND SELF-MONITORING OF BLOOD GLUCOSE IN ADOLESCENTS WITH TYPE 1 DIABETES MELLITUS

Abstract

Insulin pump and Continues Glucose Monitoring (CGM) for Type 1 diabetes (T1D) has been subjected to numerous cost-effectiveness analyses. However economic evidence review shows mixed results. Group of studies including NICE report shows that CGM and insulin pump is not cost-effective, another group demonstrated cost-effectiveness of intervention. In addition, none of the studies conducted an economic evaluation on adolescence. Our objective was to assess the cost-effectiveness of Insulin pump and CGM versus multiple daily injections and self-monitoring of blood glucose in adolescents with T1D and understand why economic evidences show mixed results. The cost-effectiveness analysis used a Markov model that took Uzbekistan health system perspective with a lifetime time horizon. We obtained probabilities, utilities and mortalities from DCCT/EDIC trial and other clinical studies in adolescence with T1D. The costs and resource utilization were obtained from the Institute of Endocrinology hospital. Outcomes were quality-adjusted life-years (QALYs) and costs. Probabilistic and deterministic sensitivity analyses were used to incorporate parameter uncertainties. Incremental cost-effectiveness ratios (ICERs) ranged from $18,536 to $40,235 per QALY gained in analysis comparing new intervention to usual care. In this analysis, treatment effect maximizes in the first 12 months and slowly deteriorates after. This is much higher than Willingness-To-Pay threshold of USD $4,512/QALY used for Uzbekistan. However, when we keep treatment effect constant over patient’s lifetime, our interventions become cost-effective ranging from $3,457 to $5,138/QALY, although this was over estimate the new intervention. Conclusions: Insulin Pump and CGM was associated with higher costs and small increases in health benefits compared to usual care in T1D. However, there was considerable uncertainty about value for money, given the nature of the available evidence.