Yet, a Cochrane review concluded in 2010 that although some evidence indicates that insulin pumps improve glycemic control compared with standard multiple daily injection (MDI) therapy, insufficient evidence exists regarding mortality, morbidity, and costs (1). Longitudinal health and socioeconomic data were collected from the National Patient Register, National Prescribed Drug Register, National Cause of Death Register and National Integrated Database for Labor Market Research. Pediatr Diabetes 2008; 9 (4pt1): 291-6. doi: 10.1111/j.1399-5448.2008.00396.x pmid: 18466210 The main study variables were number of inpatient and outpatient events; costs of inpatient care, outpatient care, medication, and disposables; sickness benefit, early retirement benefits, and unemployment benefits; and all data summarized annually. Continuous subcutaneous insulin infusion, or insulin pump, therapy for individuals with type 1 diabetes has increased gradually since the 1980s. However, the cost increments for insulin pump therapy decreased with age (differences ranging from 56% for those 18–27 years of age to 44% for those ≥48 years [reference: MDI 18–27 years]). Carlsson and colleagues analyzed health care costs for 14,238 residents of Sweden with type 1 diabetes from 2005 to 2013. A heterogeneous distribution of events was found across nontreatment characteristics: ∼70% of all cardiovascular events occurred among individuals 48 years of age or older, and >90% of the events occurred among individuals with diabetes duration ≥20 years at baseline. Equipment costs include the glucose meters and consumables (lancets and test strips), insulin pens and consumables (needles), and insulin pumps and consumables (batteries, and infusion sets). Mean age at baseline was 34 years, with 21 years of diabetes duration and a mean HbA1c of 8.1% (65 mmol/mol). Make sure you speak to your diabetes specialist about if this is the best option for your child. Identification of tangible and intangible patient benefits from insulin pump therapy over time remain important to the valuation of technology and support of resource allocation decisions. Mean annual costs were analyzed using univariate analysis. Our low observed frequencies of severe hypoglycemia and ketoacidosis may be related to the structure of diabetes care, including educational programs that do not differ with respect to insulin therapy (15). With the use of time-varying propensity scores, we allowed selected MDI control subjects to switch to pump therapy rather than to condition their eligibility or noneligibility on a future therapeutic change. Some questions cannot be answered yet. Further description of the matching strategy is provided in the Supplementary Data. Age-related cost differences were driven by an increasing impact of production loss with age from an increasing percentage of person-years with at least some production loss (18–27 years 17%, 28–37 years 29%, 38–47 years 37%, ≥48 years 42%). The controls are located on the pump, which is kept in your pocket. Research design and methods: Individuals with type 1 diabetes and pump therapy in the Swedish National Diabetes Register (NDR) since 2002 were eligible. The previous study investigated the relative risks of complications on the basis of time to the first event, whereas the current study summarized costs of all events of complications and regular health care use, medications, and production loss, given that all contribute to total annual costs. Typical costs: According to the Academy of Managed Care Pharmacy [ 1 ] , insulin pumps cost between $4,500 and $6,500 for individuals without insurance. “In practice, where individuals with type 1 diabetes face challenges of the disease in daily management, the two modes of insulin administration could differ in effectiveness, ease of use and association with adverse events, and, therefore, be associated with differences in patient outcomes.”. Regression analyses showed higher costs for low education, low disposable income, women, and older age. “Whether insulin pump therapy is cost-efficient, ultimately, depends on therapeutic effects beyond resource use and costs as well as on how much the payer is prepared to invest in additional quality-adjusted life-years,” the researchers wrote. This allows patients to avoid multiple needle pricks and insulin injections each day. are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Relevance: Blair, et al. Insulin via subcutaneous injection delivers insulin … While there are many different insulin pumps available on the market, there are typically two kinds of pumps you can get. Based on a Medtronic survey of the average cost of $3.28 per day for hospital policies with coverage for insulin pumps. This is a great feature that I have yet to use. Our national real-world longitudinal data show additional costs for insulin pump therapy. Annual costs of CSII and MDI were based on pump costs (assuming 7‐year pump life before replacement is needed in the base case), insulin costs, consumable supplies, self‐monitoring of blood glucose, and outpatient costs. Attrition of the panel was a result of death. AIMS: To estimate the cost effectiveness of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) for patients using insulin pumps. However, just over the … But more than 90 years after its discovery, a low-cost version is no longer available in the U.S. As the longest and largest study of the effectiveness of pump therapy, the study found that episodes of severe hypoglycaemia (dangerously low blood glucose) more than halved, while events in the control group increased. The sensitivity analyses of cohort specifications and matching criteria indicated that average annual costs for individuals with type 1 diabetes were robust and similar to results from the main analysis (pump therapy range −0.6% to −8.5%, MDI range 0.5% to −10.5%) (full results in Supplementary Table 9). RESULTS A total of 14,238 individuals with type 1 diabetes entered in the NDR between 2005 and 2013 (insulin pump n = 4,991, MDI n = 9,247, with switches allowed during the study) were included. All prices are at the 2013 level, using the Consumer Price Index to adjust costs of medications, disposables, and income and the Län (County) Price Index to adjust prices of appointments. Cost of a pump is prohibitive ... about a 300 mg/dL because the insulin isn’t getting through a new infusion site properly than simply taking 1 basal insulin injection and 4 to 6 rapid-acting bolus injections per day. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. But if self funding, let's say 4 injections a day vs a pump. The number of events related to kidney disease was driven by a few individuals with manifest kidney disease and frequent appointments. designed and conducted the matching of study cohorts. For heavy insulin users, pumps were much less expensive at $28,826 versus $41,100 for injections. Observational studies provide a better indication of what is achieved in daily medical practice than randomized controlled studies (12). With tube insulin pumps cost less than tubeless or implanted pumps. We accounted for nonrandom selection into type of insulin treatment by propensity score matching conditioned on clinical, individual, and socioeconomic factors. In principle, optimal glycemic control may be achieved by either MDI or insulin pump therapy. Acknowledgments. Total daily insulin doses were also lower with an insulin pump therapy (0.84 U/kg) than with injections therapy (0.98 U/kg); (difference, −0.14 [−0.15 to −0.13], P < .001). For moderate insulin users, the costs were about the same at $22,380 for injections and $23,002 for pump therapy. Published models have identified change in HbA1c and reduction in number of hypoglycemic events as important drivers of costs. The study cohort was younger than the average individual with type 1 diabetes in the NDR (34 vs. 46 years), had a shorter duration of diabetes (21 vs. 24 years), and had a higher HbA1c (8.1 vs. 7.8% [65 vs. 62 mmol/mol]) at baseline. No tedious technical management. In practice, where individuals with type 1 diabetes face challenges of the disease in daily management, the two modes of insulin administration could differ in effectiveness, ease of use, and association with adverse events and, therefore, be associated with differences in patient outcomes (1,3,4). SBU Alert-rapport 2013-03) [in Swedish], Sign In to Email Alerts with your Email Address. Insulin pump costs . The corresponding cost for a 40-year time horizon is $95,000. Duality of Interest. OBJECTIVE To investigate real-world costs of continuous insulin pump therapy compared with multiple daily injection (MDI) therapy for type 1 diabetes. We found lower rates of events in our adult population than the German-Austrian study (14). Pump users also had relatively more events related to ketoacidosis, hyperglycemia, and atrial fibrillation, but all those rates were <50 per 1,000 person-years. This pump uses a tube to connect the pump to the cannula. Neither has received payment outside of normal salary related to the subject matter of this work. Most people in the UK who have a pump have it funded by the NHS. Stockholm, Sweden, Statens beredning för medicinsk och social utvärdering, 2013 (publication no. Annual resource use and annual costs in 2005–2013 for individuals with type 1 diabetes on insulin pump or MDI therapy. Insulin therapy is crucial to the treatment of many patients with diabetes mellitus. The DRG code was linked with the corresponding yearly DRG weight (Swedish National Board of Health and Welfare [8,9]). Similarly, with a threshold of $100,000, the required gain in annual QALYs would have to be between 0.03 and 0.06. S.G. and K.S.C. Extended bolus. Certain medical supplies used to inject insulin, like syringes, gauze, and alcohol swabs; However, if you use an external insulin pump, insulin and the pump may be covered as durable medical equipment (DME) under Part B. Health care costs, including medications and disposables, accounted for 73% of the costs for pump therapy and 63% of the costs for MDI therapy. B: By HbA1c on the index date, among people whose insulin pump therapy started after NDR entry, and among insulin pump users observed for at least 6 years in NDR. This study followed 345 young people on pump therapy over the course of seven years, matching them to controls using insulin injections. Pump users were less likely to have a period of unemployment (unadjusted OR 0.803 [95% CI 0.721–0.894], adjusted OR 0.821 [0.736–0.915]). Individuals with HbA1c ≥8.6% (≥70 mmol/mol) at baseline had the smallest cost difference between treatment groups across all subgroups (pump $13,309 vs. MDI $10,966; P < 0.001). In addition, higher HbA1c levels at enrollment in the Swedish National Diabetes Register were associated with increased costs (P <.001), as was starting therapy at age 18 years or older compared with younger (P < .001). A small difference was found in mean sickness benefits between the treatment groups but no significant difference in early retirement benefits. A Swedish health technology assessment review in 2013 did not find evidence for differences in severe hypoglycemia between pump therapy and MDI but identified indications of lower HbA1c (13). Cost of a pump is prohibitive ... about a 300 mg/dL because the insulin isn’t getting through a new infusion site properly than simply taking 1 basal insulin injection and 4 to 6 rapid-acting bolus injections per day. All costs are indexed to 2013 values. Longitudinal data on health care resource use, antidiabetes treatment, sickness absence, and early retirement were taken from national registers for 2005–2013. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548. Insulin pumps, cartridges, and infusion sets may be far more expensive than syringes used for insulin injection. RESEARCH DESIGN AND METHODS Individuals with type 1 diabetes and pump therapy in the Swedish National Diabetes Register (NDR) since 2002 were eligible. Explanatory variables included an indicator for insulin treatment therapy, demographics (sex, marital status), and socioeconomic characteristics (logarithm of disposable income, level of education). Even with a median duration of diabetes of 21 years at baseline, the mean cost per patient-year of cardiovascular comorbidities and diabetic complications was low because of the overall low rates of events. Insulin Pump Cost Comparison. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. The overall incidence rate of first events with cardiovascular disease for this study cohort was 9 per 1,000 person-years, whereas the corresponding figure for the previous study was 12.5 per 1,000 person-years. Including unemployment benefits, a small difference was found in total production loss, with higher costs in the pump users (P = 0.041). Now, with the pump, it’s one injection every 3 days. Cost based on 1 box of 10 i-Port ™ Advance injection ports per month * The testimonial above relates an account of an individual's experience using a Medtronic device. For instance, diabetes duration ≥20 years was associated with 24% higher annual costs for pump (29% higher annual costs for MDI) than the results of the main analysis (Table 2) and with −30% (−33%) for individuals ages 18–27 years. The difference in study design and construction of cohorts suggests that cohort characteristics may differ. We considered observations with ≤24 months between multiple entries in the NDR as valid for analysis of continuous treatment. 2019;doi:10.2337/dc18-1850. The difference in the annual total cost between the therapy groups was $3,923 (95% CI $3,703–$4,143). The economic analyses were performed with Stata 14 software (StataCorp, College Station, TX). When it comes to scientific studies, comparing various outcome parameters of insulin pump vs. multiple daily injection therapy have yielded mixed results. We performed 13 subgroup analyses to evaluate the robustness of the estimates of level of costs and differences between treatment groups. The pump acquisition cost was amortized over 5 years. Insulin pump costs The cost of insulin pumps is often between £2000 and £3000. We do not capture any email address. DRG Statistics 2014—A Description of Healthcare Consumption in Sweden. “Identification of tangible and intangible patient benefits from insulin pump therapy over time remain important to the valuation of technology and support of resource allocation decisions.” – by Phil Neuffer. The univariate analysis of mean values used the t test for differences between the therapy groups on the basis of the central limit theorem, guaranteeing near normality of sample means (11). However, real-world data on health care and societal costs of insulin pump therapy compared with MDI therapy are scarce. A single pump cost about $5,500 dollars already, while the supplies cost about $100 monthly. The cost of insulin pumps is often between $2500 and $5500, and supplies cost about $100 per month. At the time of the study, E.T.G. BMJ. We used diagnosis-related group (DRG) codes and the main diagnosis to assign costs to inpatient and outpatient specialist appointments. A.-M.S. This large nationwide study of 4,991 individuals with type 1 diabetes and insulin pump therapy and 9,247 propensity score–matched control subjects with MDI treatment showed higher annual total costs for pump therapy (∼$3,900). Objectives To assess 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. If that were the case, the incidence of diabetic complications would not differ between the two treatment alternatives, at least not those associated with maintaining adequate glycemic control. Objective: To investigate real-world costs of continuous insulin pump therapy compared with multiple daily injection (MDI) therapy for type 1 diabetes. A systematic review of cost-effectiveness studies summarized comparisons of insulin pump and MDI therapy using model analyses to describe the expected impact on long-term costs, development of complications, and quality of life (2). 20 Years of Successful Improvements. Before I was on the pump I would give about 10 injections a day (including my long-acting insulin). The Swedish Association of Local Authorities and Regions funds the NDR. For moderate insulin users, the costs were about the same at $22,380 for injections and $23,002 for pump therapy. Stockholm, Sweden, Socialstyrelsen, 2016 (publication no. Table 1 shows baseline characteristics for 15,030 individuals with type 1 diabetes (pump n = 5,010, MDI n = 10,020). Mean annual costs were higher for pump therapy than for MDI therapy ($12,928 vs. $9,005, respectively; P < 0.001; mean difference $3,923 [95% CI $3,703–$4,143]). The plentiful data allowed us to match two control subjects to each pump user to account for the variance in cost variables and enabled extensive subgroup and sensitivity analyses. She has given up her insulin pump and gone back to injections because of expense. Identification of tangible and intangible benefits of pump therapy over time remain important to support resource allocation decisions. Higher annual costs in individuals with insulin pump therapy ≥6 years during 2005–2013 (mean follow-up time 8 years) and in their matched control subjects, as well as a greater cost difference, were associated with costs of medications, disposables, and production loss. It really depends where you live! We assumed that 28% of MDI users in the United States use pen devices and inject four times per day (Medtronic data on file). y, years. Diabetes Care. The risk also increased with age and disposable income, which may relate to sickness benefits being contingent on having a certain level of income. And please don’t be fooled into believing that an insulin pump provides better control. With tube insulin pumps cost less than tubeless or implanted pumps. Most people in the UK who have a pump have it funded by the NHS. Admissions for diabetic ketoacidosis were lower in the insulin-pump group than in the insulin-injection group -- 2.3 and 4.7 per 100 patients per year, respectively, according to the study. A lack of comparable calculations of total costs of diabetes treatment has been published to date, but cost-effectiveness studies of pump and MDI therapy have predicted long-term costs for the two treatment methods. Pump users were more likely to have at least one period of sick leave (unadjusted OR 1.308 [1.224–1.398], adjusted OR 1.265 [1.184–1.353]), as were women. Insulin Pump Cost Comparison. The distribution of annual costs was left-skewed with a tail of observations with high costs, although the most person-years incurred costs corresponding to typical insulin therapy and up to two regular follow-up appointments (Supplementary Fig. Enter multiple addresses on separate lines or separate them with commas. still is. Subgroup analyses revealed expected and substantial differences in average annual costs by diabetes duration and age (Fig. Insulin pumps are expensive and no matter the style or brand will cost at least several thousand dollars. As the longest and largest study of the effectiveness of pump therapy, the study found that episodes of severe hypoglycaemia (dangerously low blood glucose) more than halved, while events in the control group increased. This is a great feature that I have yet to use. Pumps are recommended for children under 12 when multiple daily insulin injections aren’t practical or appropriate. Individuals were included in the analyses up to 31 December 2012, and each observation was followed until 31 December 2013 for all outcomes. A: By sex, age, and diabetes duration in year of observation. The strength of this observational study is the size and completeness of the study population, with virtually all adults with type 1 diabetes in Sweden included, longitudinal national register data, and a matching technique that accounts for time-variant variables, including diabetes duration, diabetes-related conditions and comorbidities, and demographic and socioeconomic factors. Control subjects on MDI were matched 2:1 using time-varying propensity scores. Subgroup analyses by age indicated that the value of improved prevention may take time to manifest. We selected two control subjects for each insulin pump user, defining the index date as the date of entry in the NDR for those with ongoing insulin pump therapy since childhood/adolescence or the first registration of insulin pump therapy in the NDR. Overall, we found similar results for both study groups in terms of health care resource use other than medications and disposables. Nevertheless, type 1 diabetes is associated with an increased risk of cardiovascular disease compared with the general population (16–18), and available effective means in diabetes care should be used to further increase the proportion meeting therapeutic targets. 4). Please see the study for all other authors’ relevant financial disclosures. Effects of insulin pump vs. injection treatment on quality of life and impact of disease in children with type 1 diabetes mellitus in a randomized, prospective comparison. 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