The Health Service and Economic Impact of Glucagon Rescue Administration During Severe Hypoglycemic Events.

Abstract

Hypoglycemia, which if left untreated, can be severe and result in seizures, unconsciousness, and coma, during which another person’s help is required to administer a rescue dose of glucagon. Injectable glucagon kits are difficult to use and require training to administer. This study aimed to quantify the economic impact of using glucagon kits on resource use and costs, and identify evidentiary gaps requiring future research. A conceptual model was developed illustrating the series of events resulting from a SHE: successful administration of glucagon, ambulance calls, transport to the ED, inpatient admission, and outpatient follow-up. A literature search was conducted to assess service use and costs associated with severe hypoglycemia events (SHE). English language articles were reviewed in PubMed, EMBASE and Cochrane databases. Resource use associated with SHE, as a function of successful administration of glucagon, has not been systematically evaluated in the literature. Uncertainty exists for the probability of receiving a glucagon prescription for diabetics and successful use of glucagon kits. Furthermore, based on successful administration of glucagon, the probability of ambulance calls, transports to the ED, inpatient admissions, and frequency of outpatient follow-up are lacking in the literature. Diabetes is a costly condition for payers, and a common complication is hypoglycemia. Glucagon kits are effective in stabilizing diabetics’ blood glucose levels during SHE; however, oftentimes physicians do not prescribe, patients do not fill, or caregivers do not successfully administer glucagon due to the complex administration procedures. As less complicated glucagon products are developed, their value propositions must be informed by the economic implications resulting from the complex administration requirements of current kits. However, the current literature does not systematically evaluate these implications. Consequently, future research is needed to quantify the impact of non-successful administration of glucagon rescue kits, as well as the extent of under-utilization.