Cost-utility analysis of continuous infusion pump with integrated monitoring compared with multiple daily injection treatment for patients 15-years or older with type 1 diabetes mellitus in Colombia

Abstract

Objectives: To estimate the incremental cost-utility ratio (ICUR) for the use of a continuous infusion pump with integrated monitoring (SAP) compared with the application of multiple daily injections (MDI) in adult (>15 year-old) patients with type 1 diabetes mellitus (DM1) in Colombia. Method(s): We designed an annual cycle Markov model, with transition probabilities obtained from a systematic review of the literature. Outcomes included in the search were ketoacidosis, severe hypoglycemia, microvascular complications (retinopathy, nephropathy, neuropathy), quality of life (expressed in quality-adjusted life years, QALYs, and obtained from Tufts database), as well as mortality. Other features of the model were: discount rate 3.5% for costs and QALYs, third party payer perspective (only direct medical costs), and a lifespan time horizon (up to 55 years). Threshold used was three times per capita gross domestic product (GDP), equivalent to 17,547. Costs were estimated in 2014 Colombian pesos (1 euro = 2,660 COP), from base case scenarios (built by expert panels) and official tariff manuals. Univariate and probabilistic sensitivity analysis were performed. Result(s): For the average patient, continuous infusion pump has a total expected cost of 199,296, and generates 16.40 QALYs, while multiple daily injections would cost 104737, and generate 14.48 QALYs (ICER 49,302 per additional QALY gained). Sensitivity analysis shows that the only critical variable is the annual cost of continuous infusion pump treatment, which would have to be reduced by 40% to reach the cost-utility threshold. Conclusion(s): Under the assumptions of the model, treatment with continuous infusion pumps would not be cost-effective for the average adult DM1 patient in Colombia. Further analysis would be required, addressed to certain selected subgroups of patients.