Event and cost offsets of a partial switch from multiple daily injections to continuous subcutaneous insulin infusion in type 1 diabetes patients in Germany: a four-year simulation model

Background: Most type 1 diabetes mellitus (T1D) patients administer insulin by multiple daily injections (MDI). However, continuous subcutaneous insulin infusion (CSII) therapy has been shown to improve glycaemic control and health-related quality of life (QoL).

Objective: To determine the key medical event and cost offsets, over a 4-year period, generated by introducing CSII for T1D patients currently inadequately controlled on an MDI regimen in Germany.

Methods: A decision-analytic model, simulating a switch scenario, was developed. In the base case, all T1D patients receive MDI, while in the switch scenario, 20% of eligible patients, randomly selected, move to CSII. The model focuses on two medical endpoints and their corresponding cost offsets: Severe hypoglycaemic events requiring hospitalisation (SHEH) and complication-borne diabetic (micro and macrovascular) events (CDE) avoided. Epidemiologic and cost figures were taken from the literature and official sources, adopting a health insurance perspective.

Results: Compared to the base case, the switch scenario resulted in 47,864 fewer SHEH and 4,513 fewer CDE, including 412 fewer deaths. This led to total cost offsets of 183,846,557 € within the 4-year time horizon considered. Of these, 92% are driven by avoided short-term SHEH.

Conclusion: The use of CSII results in fewer SHEH, CDE and deaths. Cost offsets arising from avoided SHEH and CDE are probably underestimated, as the model is conservative (excluding e.g. emergency admissions and assuming a random rather than targeted switch). The incurred CSII implementation costs are hence substantially offset by cost savings elsewhere. QoL benefits can be regarded as an additional bonus.

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