Cost-effectiveness of Initiating an Insulin Pump in T1D Adults Using Continuous Glucose Monitoring Compared with Multiple Daily Insulin Injections: The DIAMOND Randomized Trial

Overview

Journal Med Decis Making

Publisher Sage Publications

Date 2018 Nov 8

PMID 30403576

Citations 5

Authors

Wen Wan

M Reza Skandari

Alexa Minc

Aviva G Nathan

Parmida Zarei

Aaron N Winn

Michael OGrady

Elbert S Huang

Affiliations

Soon will be listed here.

Abstract

Background: The economic impact of both continuous glucose monitoring (CGM) and insulin pumps (continuous subcutaneous insulin infusion [CSII]) in type 1 diabetes (T1D) have been evaluated separately. However, the cost-effectiveness of adding CSII to existing CGM users has not yet been assessed.

Objective: The aim of this study was to evaluate the societal cost-effectiveness of CSII versus continuing multiple daily injections (MDI) in adults with T1D already using CGM.

Methods: In the second phase of the DIAMOND trial, 75 adults using CGM were randomized to either CGM+CSII or CGM+MDI (control) and surveyed at baseline and 28 weeks. We performed within-trial and lifetime cost-effectiveness analyses (CEAs) and estimated lifetime costs and quality-adjusted life-years (QALYs) via a modified Sheffield T1D model.

Results: Within the trial, the CGM+CSII group had a significant reduction in quality of life from baseline (-0.02 ± 0.05 difference in difference [DiD]) compared with controls. Total per-person 28-week costs were $8,272 (CGM+CSII) versus $5,623 (CGM+MDI); the difference in costs was primarily attributable to pump use ($2,644). Pump users reduced insulin intake (-12.8 units DiD) but increased the use of daily number of test strips (+1.2 DiD). Pump users also increased time with glucose in range of 70 to 180 mg/dL but had a higher HbA1c (+0.13 DiD) and more nonsevere hypoglycemic events. In the lifetime CEA, CGM+CSII would increase total costs by $112,045 DiD, decrease QALYs by 0.71, and decrease life expectancy by 0.48 years.

Conclusions: Based on this single trial, initiating an insulin pump in adults with T1D already using CGM was associated with higher costs and reduced quality of life. Additional evidence regarding the clinical effects of adopting combinations of new technologies from trials and real-world populations is needed to confirm these findings.

Citing Articles

MDI versus CSII in Chinese adults with type 1 diabetes in a real-world situation: based on propensity score matching method.

Yu J, Wang H, Zhu M, Xu J Health Qual Life Outcomes. 2024; 22(1):47.

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Monitoring of continuous subcutaneous insulin infusion treatment in Portugal and its implications for diabetes management.

Figueiredo A, Matos T, do Vale S Hormones (Athens). 2022; 22(1):87-94.

PMID: 36336764 DOI: 10.1007/s42000-022-00412-8.

RT-CGM in conjunction with CSII vs MDI in optimizing glycaemic control in T1DM: Systemic review and meta-analysis.

William J, McCluskey J, Gleeson N Endocrinol Diabetes Metab. 2022; 5(2):e00324.

PMID: 35118826 PMC: 8917862. DOI: 10.1002/edm2.324.

Costs and Outcomes Comparison of Diabetes Technology Usage Among People With Type 1 or 2 Diabetes Using Rapid-Acting Insulin.

Vallarino C, Wong-Jacobson S, Benneyworth B, Meadows E J Diabetes Sci Technol. 2021; 17(2):439-448.

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Healthcare Utilization, Costs, and Adverse Events of Real-Time Continuous Glucose Monitoring versus Traditional Blood Glucose Monitoring Among US Adults with Type 1 Diabetes.

Wong B, Deng Y, Rascati K J Diabetes Sci Technol. 2021; 16(6):1393-1400.

PMID: 34388953 PMC: 9631528. DOI: 10.1177/19322968211031519.

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