Continuous subcutaneous insulin infusion (CSII) in T2DM improves HbA1c and reduces insulin dosage vs. multiple daily injections (MDI). However, for T2DM traditional CSII can be costly and overly sophisticated. Emerging evidence shows T2DM can be treated with limited numbers of fixed basal rates and simple bolusing (‘simple CSII’) e.g., PAQ®, a 3-day wearable device (CeQur Corporation, Marlborough, MA), as alternatives to traditional CSII. This analysis investigated cost-effectiveness in the U.S. of simple CSII vs. MDI in poorly controlled T2DM, assuming similar efficacy of traditional and simple CSII. The analysis used data from a systematic review of relationships between reduced HbA1c and increased life-expectancy and quality-adjusted life-years (QALYs). Relationships between baseline HbA1c and simple CSII vs. MDI HbA1c treatment difference were based on data from either a 5-trial meta-analysis or a large single trial (OpT2mise study). Incremental cost-effectiveness ratios of costs per QALY gained below 1xGDP per capita (2016: USD 57,467) were defined as ‘highly cost-effective’ and below 3xGDP as ‘cost-effective’. Using meta-analysis data, simple CSII devices can be cost-effective below a unit cost about $18, and below $26 per patient per day using OpT2mise data. In either case, simple CSII is potentially a highly cost-effective treatment option in poorly controlled T2DM.
P. Wahlqvist: Employee; Self; CeQur (Wales) Ltd. J.L. Warner: Employee; Self; CeQur Corporation. J.C. Pickup: Advisory Panel; Self; Medtronic, Roche Diabetes Care Health and Digital Solutions. Speaker's Bureau; Self; Roche Diabetes Care Health and Digital Solutions, CeQur Corporation. Consultant; Self; CeQur Corporation. Advisory Panel; Self; Novo Nordisk A/S. Consultant; Self; Medtronic. Speaker's Bureau; Self; Berlin-Chemie AG, Elsevier.
