English, Article edition: Continuous Subcutaneous Insulin Infusion versus Multiple Daily Injections of Insulin: Economic Comparison in Adult and Adolescent Type 1 Diabetes Mellitus in Australia Neale Cohen; Michael E. Minshall; Lyn Sharon-Nash; ...

User activity

Share to:
 
Bookmark: http://trove.nla.gov.au/version/119215
Physical Description
  • article
Language
  • English

Edition details

Title
  • Continuous Subcutaneous Insulin Infusion versus Multiple Daily Injections of Insulin: Economic Comparison in Adult and Adolescent Type 1 Diabetes Mellitus in Australia
Author
  • Neale Cohen
  • Michael E. Minshall
  • Lyn Sharon-Nash
  • Katerina Zakrzewska
  • William J. Valentine
  • Andrew J. Palmer
Physical Description
  • article
Notes
  • Background: Recent meta-analyses in the published medical literature have found improved glycaemic control with continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) of insulin for patients with diabetes mellitus. In Australia, CSII is predominantly used in type 1 diabetes mellitus (T1DM) patient populations. Objective/​intervention: To project long-term costs and outcomes of CSII (Novorapid(R) or Humalog(R)) compared with MDI (NPH insulin plus Novorapid(R) or Humalog(R)) in adult and adolescent T1DM patients in Australia. Methods: The study was a modelling analysis utilising a lifetime horizon in adult and adolescent specialty care T1DM patient populations from Australia. Published Australian diabetes complication costs (adjusted to Australian dollars [$A], year 2006 values), treatment costs and discount rates of 5.0% per annum were applied to costs and clinical outcomes. A lifetime horizon was taken, considering only direct medical costs and excluding indirect and non-medical costs. The validated CORE diabetes model employs standard Markov/​Monte Carlo simulation techniques. It was used to simulate diabetes progression in Australian adult (mean age 43 years, duration of diabetes 17 years, mean glycosylated haemoglobin [HbA1c] 8.2%) and adolescent (mean age 17 years, duration of diabetes 6 years, mean HbA1c 8.9%) patients with baseline characteristics taken predominantly from Australian National Diabetes Information Audit and Benchmarking (ANDIAB) in Australia. The main outcome measures were incremental costs and effectiveness of CSII compared with MDI in Australian adult and adolescent patients with T1DM. Results: Mean direct lifetime costs were $A34_642 higher with CSII treatment than with MDI for adult patients and $A41_779 higher for adolescent patients. Treatment with CSII was associated with an improvement in life expectancy of 0.393 years for adults compared with MDI and 0.537 years for adolescents. The corresponding gains in QALYs were 0.467 QALYs and 0.560 QALYs for adults and adolescents, respectively. This produced incremental cost effectiveness ratios (ICERs) of $A88_220 and $A77_851 per life-year gained for CSII compared with MDI for adult and adolescent T1DM patients, respectively, in Australia. These data also produced corresponding ICERs of $A74_147 per QALY and $A74_661/​QALY for adult and adolescent T1DM patients, respectively. Sensitivity analyses suggested that our base-case assumptions were mostly robust with improvements in ICERs for reduction in hypoglycaemic events with CSII treatment and worse ICERs for lower HbA1c changes associated with CSII treatment compared with MDI. Conclusions: Our analysis suggests that CSII is associated with ICERs in the range of $A53_022-259_646 per QALY gained, with most ICERs representing good value for money in Australia under the majority of scenarios explored.
  • Cost-utility, Insulin-aspart, Insulin-lispro, Insulin-suspension-isophane, Type-1-diabetes-mellitus
  • RePEc:wkh:phecon:v:25:y:2007:i:10:p:881-897
Language
  • English
Contributed by
OAIster

Get this edition

  • Set up My libraries

    How do I set up "My libraries"?

    In order to set up a list of libraries that you have access to, you must first login or sign up. Then set up a personal list of libraries from your profile page by clicking on your user name at the top right of any screen.

  • All (1)
  • Unknown (1)
None of your libraries hold this item.
None of your libraries hold this item.
None of your libraries hold this item.
None of your libraries hold this item.
None of your libraries hold this item.
None of your libraries hold this item.
None of your libraries hold this item.
None of your libraries hold this item.

User activity


e.g. test cricket, Perth (WA), "Parkes, Henry"

Separate different tags with a comma. To include a comma in your tag, surround the tag with double quotes.

Be the first to add a tag for this edition

Be the first to add this to a list

Comments and reviews

What are comments? Add a comment

No user comments or reviews for this version

Add a comment