The current data represent real-world use of insulin pumps in 2005–2013, with significant proportions of young adults and other individuals who had <20 years of diabetes duration. This is very difficult to answer straight off the bat, because this is a highly individual topic. “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. For moderate insulin users, the costs were about the same at $22,380 for injections and $23,002 for pump therapy. Cost & Reputed Branded Insulin Pump. 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. The ethical review board at the University of Gothenburg approved the study. Pump users also spent more annually on medication costs, including disposables ($5,861; 95% CI, 5,814-5,907), than multiple daily injection users ($2,285; 95% CI, 2,270-2,300). Cox proportional hazard functions were used to account for time-variant covariates in the matching equations and to model the time since last measurement for control subjects (7). Available from, Swedish National Board of Health and Welfare (Ed.). Research design and methods: Individuals with type 1 diabetes and pump therapy in the Swedish National Diabetes Register (NDR) since 2002 were eligible. 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. This pump uses a tube to connect the pump to the cannula. Insulin pumps, cartridges, and infusion sets may be far more expensive than syringes used for insulin injection. The Swedish National Diabetes Register. The largest cost difference was found for individuals with middle HbA1c levels (6.5–8.5% [48–69 mmol/mol], pump $12,824 vs. MDI $8,083; P < 0.001). Also, being attached to the pump via tubing or pod is a 24/7 thing and for some this makes a pump a constant reminder of diabetes. Insulin pump costs The cost of insulin pumps is often between £2000 and £3000. Stockholm, Sweden, Socialstyrelsen, 2016 (publication no. 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. According to the same website, the average insulin pump price, is expensive and some patients cannot afford it, not without the help of their insurance coverage. Longitudinal data on health care resource use, antidiabetes treatment, sickness absence, and early retirement were taken from national registers for 2005–2013. Stockholm, Sweden, Statens beredning för medicinsk och social utvärdering, 2013 (publication no. 4) Expense With pumps, cost is surely a consideration. A single pump cost about $5,500 dollars already, while the supplies cost about $100 monthly. (2) performed a meta-review of model-based studies that compared pump therapy and MDI, concluding that pump therapy can be cost effective. Subgroup analysis revealed that health care costs, both for pump therapy and multiple daily injections, were higher for women compared with men (P < .001), adults aged at least 48 years compared with younger adults (P < .001) and those with diabetes duration of 20 years or more compared with shorter duration (P < .001). CBS News quotes a college student saying her bill for insulin has risen from $130 to $495 per month. Recently, a randomized study assessed the value of introducing insulin pump therapy in patients with type 1 diabetes who were already using a continuous glucose monitor (CGM) . Periods of sick leave <14 days are not included in national registers, and some of the workforce may not yet be eligible for unemployment benefits (e.g., young people with short contracts). 2016-5-9) [in Swedish], Statistics Sweden (Ed.). Relevance: Blair, et al. 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). This study followed 345 young people on pump therapy over the course of seven years, matching them to controls using insulin injections. NICE guidance in 2008 records the following costs of insulin pumps: Use of real-world data implied imperfect entry over time for treatment and missing data among the clinical variables in the NDR. 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. Total costs were higher for women but decreased with years of education and disposable income. Descriptive statistics of preindex date individual, clinical, disease, and socioeconomic characteristics. Using the often high within-patient correlation in clinical and socioeconomic data between years, missing data were imputed in three steps starting with the 1) last value carried forward, 2) first value carried backward, and 3) single stochastic imputation on the basis of a multivariate normal distribution. still is. Real-World Costs of Continuous Insulin Pump Therapy and Multiple Daily Injections for Type 1 Diabetes: A Population-Based and Propensity-Matched Cohort From the Swedish National Diabetes Register, Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus, Cost-effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections of insulin in type 1 diabetes: a systematic review, Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis, Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study, Insulin pump therapy, multiple daily injections, and cardiovascular mortality in 18,168 people with type 1 diabetes: observational study, Propensity score matching with time-dependent covariates, Review of statistical methods for analysing healthcare resources and costs, Comparison of evidence on harms of medical interventions in randomized and nonrandomized studies, Association of insulin pump therapy vs insulin injection therapy with severe hypoglycemia, ketoacidosis, and glycemic control among children, adolescents, and young adults with type 1 diabetes, Cost-effectiveness of insulin pumps compared with multiple daily injections both provided with structured education for adults with type 1 diabetes: a health economic analysis of the Relative Effectiveness of Pumps over Structured Education (REPOSE) randomised controlled trial, Range of risk factor levels: control, mortality, and cardiovascular outcomes in type 1 diabetes mellitus, Mortality and cardiovascular disease in type 1 and type 2 diabetes, Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study, Postintervention Effects of Varying Treatment Arms on Glycemic Failure and β-Cell Function in the TODAY Trial, Worldwide Epidemiology of Diabetes-Related End-Stage Renal Disease, 2000–2015, Incident Type 2 Diabetes and Risk of Fracture: A Comparative Cohort Analysis Using U.K. Primary Care Records, Institutional Subscriptions and Site Licenses, Special Podcast Series: Therapeutic Inertia, Special Podcast Series: Influenza Podcasts, http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc18-1850/-/DC1, http://www.diabetesjournals.org/content/license, http://www.socialstyrelsen.se/klassificeringochkoder/norddrg/vikter. The register includes risk factors, diabetic complications, and medications. 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). The study cohort was young (mean baseline age 34 years) with relatively few diabetic complications in both study groups. Mean annual costs in 2005–2013 for people with type 1 diabetes on insulin pump or MDI therapy by subgroup. RESEARCH DESIGN AND METHODS Individuals with type 1 diabetes and pump therapy in the Swedish National Diabetes Register (NDR) since 2002 were eligible. Also, being attached to the pump via tubing or pod is a 24/7 thing and for some this makes a pump a constant reminder of diabetes. The economic analyses were performed with Stata 14 software (StataCorp, College Station, TX). With tube insulin pumps cost around $4000-$5000 each, while tubeless pumps cost around $6000-$7000 each. 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. Mean age at baseline was 34 years, with 21 years of diabetes duration and a mean HbA1c of 8.1% (65 mmol/mol). Identification of tangible and intangible benefits of pump therapy over time remain important to support resource allocation decisions. Table 3 shows the adjusted results of the cost-regression analysis, controlling for time-varying demographic and socioeconomic factors. Total annual costs increased with age for both insulin therapies, and pump therapy was associated with higher costs across age-groups. Extended bolus. Data are continuously reported by clinics through electronic records or are registered online. Subgroup analyses by age indicated that the value of improved prevention may take time to manifest. A.-M.S. 4) Expense With pumps, cost is surely a consideration. OBJECTIVE To investigate real-world costs of continuous insulin pump therapy compared with multiple daily injection (MDI) therapy for type 1 diabetes. It really depends where you live! 2016:1) [in Swedish], Swedish Agency for Health Technology Assessment and Assessment of Social Services (Ed.). No worrying. Control subjects on MDI were matched 2:1 using time-varying propensity scores. The pump works by delivering insulin to the bloodstream via a catheter inserted under the skin. The hormone that controls blood sugar among diabetics is one of the oldest medicines used today. The NDR includes ∼97% of all Swedish individuals with type 1 diabetes age 18 years and older. Costs in dollars were calculated using $1 = 6.514 SEK (annual exchange rate for 2013 from the Swedish Central Bank). The first kind is a traditional insulin pump. 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). METHODS: We constructed a Markov model to estimate the costs and outcomes for patients with insulin-dependent diabetes (IDDM) treated with CSII using an insulin pump compared with MDI. E.T.G. 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. 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. When it comes to scientific studies, comparing various outcome parameters of insulin pump vs. multiple daily injection therapy have yielded mixed results. Five of the studies reported long-term discounted incremental costs of insulin pumps of $20,000–$40,000, whereas two studies reported lower and one higher additional costs for insulin pump therapy. Insulin via subcutaneous injection delivers insulin … Nurs Manage. While there are many different insulin pumps available on the market, there are typically two kinds of pumps you can get. The indication for insulin pump is broad with no out-of-pocket expenses for the patient. The corresponding cost for a 40-year time horizon is $95,000. 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. While there are many different insulin pumps available on the market, there are typically two kinds of pumps you can get. No other potential conflicts of interest relevant to this article were reported. However, real-world data on health care and societal costs of insulin pump therapy compared with MDI therapy are scarce. 1 shows a flowchart of study inclusion and exclusion. Type 1 diabetes is defined as treatment with insulin and diagnosis at age 30 years or younger. This cohort contained the highest number of individuals. The DRG code was linked with the corresponding yearly DRG weight (Swedish National Board of Health and Welfare [8,9]). NICE guidance in 2008 records the following costs of insulin pumps: Now, with the pump, it’s one injection every 3 days. Roze et al. Insulin pumps are expensive and no matter the style or brand will cost at least several thousand dollars. 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. Table 1 shows baseline characteristics for 15,030 individuals with type 1 diabetes (pump n = 5,010, MDI n = 10,020). The difference in study design and construction of cohorts suggests that cohort characteristics may differ. Örebro, Sweden, Statistika centralbyrån, 2016 (publication no. 1A and B). To estimate the incremental cost-effectiveness ratio (ICER) of the use of continuous subcutaneous insulin infusion (CSII) therapy versus multiple daily injections (MDI) therapy in adult patients with type 1 diabetes (T1D) at the Mexican Institute of Social Security (IMSS). The remaining study years, including the year of switch, contributed to the insulin pump group for this individual. 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). Make sure you speak to your diabetes specialist about if this is the best option for your child. Corresponding author: Katarina Steen Carlsson. Socioeconomic and demographic factors associated with annual cost, 2005–2013. Insulin Pumps for Diabetes. We do not capture any email address. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. All-Cause mortality records or are registered online complications, and unemployment benefits risk for inpatient admissions was for. Absence, and decreased with disposable income article online ], Sign in to Email Alerts with Email., when treatment options differed from today ’ s harder to hide HbA1c level at baseline index. By propensity score matching conditioned on clinical, disease, and Supplementary Table )... Mean diabetes duration in year of switch, contributed to the cannula some but! And socioeconomic characteristics exchange rate for 2013 from the Swedish Central Bank ) injection delivers insulin …:... To hide HbA1c and reduction in number of events in our adult than. 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