Pollard DJ, et al. - Authors probed into the long-term cost-effectiveness of insulin pumps and Dose Adjustment for Normal Eating (pumps+DAFNE) compared with multiple daily insulin injections and DAFNE (MDI+DAFNE) for adults with type 1 diabetes mellitus (T1DM) in the UK. It was discovered that the probability of pump+DAFNE being cost-effective using a cost-effectiveness threshold of £20,000 per quality-adjusted life years (QALY) gained was 14.0%. Results unveiled that routine use of pumps in adults without an immediate clinical need for a pump, as identified by National Institute for Health and Care Excellence, would not be cost-effective.

Methods

• Using the Sheffield Type 1 Diabetes Policy Model and data from the Relative Effectiveness of Pumps over Structured Education (REPOSE) trial, this cost-utility analysis determined the lifetime incidence of diabetic complications, intervention-based resource use and associated effects on costs and quality-adjusted life years (QALYs).
• All economic analyses took a National Health Service and personal social services perspective and discounted costs and QALYs at 3.5% per annum.
• During this study, a probabilistic sensitivity analysis was performed on the base case.
• Scenario analyses assisted in examining further uncertainties in the cost of pumps and the evidence used to inform the model.
• It was performed at 8 diabetes centres in England and Scotland.
• Enrollees included adults with T1DM who were eligible to receive a structured education course and did not have a strong clinical indication or a preference for a pump.
• Pumps+DAFNE served as the intervention and MDI+DAFNE as the comparator.
• The primary outcome included incremental costs, incremental QALYs gained and incremental cost-effectiveness ratios (ICERs).

Results

• In contrast with MDI+DAFNE, pumps+DAFNE appeared to be related to an incremental discounted lifetime cost of +£18,853 (95% CI £6,175 to £31,645) as well as a gain in discounted lifetime QALYs of +0.13 (95% CI -0.70 to +0.96).
• It was reported that the base case mean ICER was £142,195 per QALY gained.
• Findings displayed that the probability of pump+DAFNE being cost-effective using a cost-effectiveness threshold of £20,000 per QALY gained was 14.0%.
• As per the scenario and subgroup analyses, the ICER was unlikely to fall below £30,000 per QALY gained.