Health-Economic Comparison of Sensor-Augmented Pump With Low Glucose Suspend Versus Insulin Pump Alone For The Treatment of Hypo-Prone Type 1 Diabetes In Hungary

Abstract

Objectives: To project the long-term costs and outcomes of sensor-augmented pump (SAP) with low glucose suspend (LGS) versus insulin pump (CSII) alone for the treatment of hypo-prone Type 1 diabetes in Hungary. Methods: The CORE Diabetes Model is a peer-reviewed, validated model, which employs standard Markov/Monte Carlo simulation techniques to describe the long-term incidence and progression of diabetes-related complications. It was used to simulate disease progression in a cohort of patients with baseline characteristics (mean age 18.6 years, duration of diabetes 12 years, mean HbA1c 7.5%) and clinical outcomes (severe hypoglycaemic event rates; Quality of Life; HbA1c) taken from a recent randomised controlled trial (Ly et al, 2013). Local treatment and complication cost data was used. The main scenario considered in this cost-effectiveness analysis was the comparison of sensor-augmented insulin pump (SAP) with low glucose suspend (LGS) versus pump alone (CSII). The target population was hypo-prone type I diabetes patients with the analysis based on a deterministic microsimulation of 1,000 patients, using a 1 to 5 year time horizon. Direct costs were calculated from a third-party payer perspective. Discount rates of 3.7% per annum were applied to both costs and clinical outcomes. Results: The Incremental-Cost-Effectiveness-Ratio (ICER) for SAP+LGS vs CSII was HUF 6,196,086 ( 20,298) per Quality-Adjusted-Life-Year gained over a 1 year time horizon. Results were similar using a 5 year time horizon (HUF 6,125,823 [ 20,068] per QALY gained). Extensive sensitivity analyses showed the robustness of the results. Conclusions: Using a payer's perspective, our analysis showed that SAP (w LGS) is cost-effective over a short term (1-5 year) time horizon in hypo prone patients with Type 1 Diabetes in Hungary (using a WTP threshold of 3x Hungary GDP).