PMD19 Multiple Daily Injection Therapy (MDI) Versus Durable Insulin Pump Therapy in Type II Diabetics: A Breakeven Analysis

Abstract

OBJECTIVES: To compare cost of care among Type II diabetic patients using an insulin pump delivery system versus alternate methods of insulin delivery (focus on multiple daily injectors [MDIs]) using administrative claims data. METHODS: This study used 2009 MarketScan Research Database data. Patients were included if they were continuously enrolled throughout 2009 and were classified as Type II diabetic based on a combination of diagnosis codes and medication claims with the final application of age where diagnosis was indeterminate. Patients were then classified as MDIs and insulin pump users based on HCPCS codes and the use of rapid or short acting insulin prescriptions. Treatment costs were the focus and included pumps, pump supplies, insulin, and drugs. Costs of complications and hospitalizations were not included. The study utilized a breakeven analysis to capture both the fixed and variable costs associated with insulin pumps versus injection across different cost percentiles of insulin and other drugs. RESULTS: A total of 68,636 Type II diabetics met inclusion criteria, of which 84% (57,418) were MDIs, and 16% (11,218) used insulin pumps. Durable insulin pumps required an upfront investment of approximately $4200 with additional pump supply costs. Insulin pump users, however, required less insulin and other drugs compared with MDI patients, resulting in less associated costs. Insulin pumps last approximately four years, and their value proposition increases with the level of insulin use required. Breakeven analysis revealed patients at the top 10th percentile of expenditures for insulin and other drugs generated savings through lower use of insulin, which offset the insulin pump cost in <3 years (1,071 days). CONCLUSIONS: Although durable insulin pumps have an upfront cost, they are better able to control insulin delivery. The reduced drug-related expenditures offset initial pump investment within three years for the most costly cohort of insulin users.