Please see the study for all other authors’ relevant financial disclosures. Data about diabetes diagnosis and insulin treatment regimens were obtained from the Swedish National Diabetes Register. When it comes to scientific studies, comparing various outcome parameters of insulin pump vs. multiple daily injection therapy have yielded mixed results. Continuous subcutaneous insulin infusion, or insulin pump, therapy for individuals with type 1 diabetes has increased gradually since the 1980s. If you live in certain areas of the country, you may have to use specific pump suppliers for Medicare to pay for an insulin pump. Subgroup and sensitivity analyses were performed. 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. The question was about whether it is necessary to use an insulin pump, or if multiple daily injections, either though a pen or syringe is better for diabetic? Each individual provides informed consent. 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. Objectives: To compare glucose profiles in patients with T1DM who use continuous subcutaneous insulin infusion (CSII) compared with those who use multiple daily injections (MDI) insulin regimen during Ramadan fast. Corresponding author: Katarina Steen Carlsson. Injection Delivery. Mean age at baseline was 34 years, with 21 years of diabetes duration and a mean HbA1c of 8.1% (65 mmol/mol). Data on the optimum insulin regimen in these patients are limited. The cost of insulin pumps is often between £2000 and £3000. All costs are indexed to 2013 values. 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. At the time of the study, E.T.G. 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. 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). Insulin pump therapy users were double-matched to 9,247 adults who used multiple injection therapy (mean age, 33.8 years; 51.3% women). 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. We obtained longitudinal health and socioeconomic data for 2005–2013 from the National Patient Register, National Prescribed Drug Register, National Cause of Death Register, and National Integrated Database for Labor Market Research. She has given up her insulin pump and gone back to injections because of expense. Three exceptions were type 1 diabetes as the main diagnosis (1,376 vs. 1,210 events per 1,000 person-years for pump vs. MDI, respectively; P < 0.001); eye disease, including diabetic retinopathy (749 vs. 670 events per person-year; P < 0.001); and kidney disease (764 vs. 633 events per person-year; P < 0.001), where the two former types included preventive care and regular follow-up of risk factors. 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. 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. If you have an insulin pump on the NHS , you may need to cover some of the costs which may include insurance, accessories and, in the case of some pumps, glucose sensors as well. The hormone that controls blood sugar among diabetics is one of the oldest medicines used today. The researchers found that annual costs for adults who used insulin pump therapy were $3,923 more than those who used multiple daily injections (95% CI, 3,703-4,143). 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). 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. Similarly, with a threshold of $100,000, the required gain in annual QALYs would have to be between 0.03 and 0.06. The NDR includes ∼97% of all Swedish individuals with type 1 diabetes age 18 years and older. However, only 70% of individuals with pump therapy could be matched, and baseline characteristics indicated high standardized differences in age, diabetes duration, and HbA1c between treatment groups in the entire cohort. If you have an insulin pump on the NHS, you may need to cover some of the costs which may include insurance, accessories and, in the case of some pumps, glucose sensors as well. 2016-5-9) [in Swedish], Statistics Sweden (Ed.). The risk for unmarried individuals was higher and showed an inverted U shape for age and education, with the highest risk for those 28–37 years old and for those with 10–12 years of education. 2019;doi:10.2337/dc18-1850. This allows patients to avoid multiple needle pricks and insulin injections each day. The remaining study years, including the year of switch, contributed to the insulin pump group for this individual. 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. “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. Funding. Here’s how it works. still is. When it comes to scientific studies, comparing various outcome parameters of insulin pump vs. multiple daily injection therapy have yielded mixed results. NICE guidance in 2008 records the following costs of insulin pumps: Get the latest news and education delivered to your inbox, Receive an email when new articles are posted on, Please provide your email address to receive an email when new articles are posted on, Tell us what you think about While there are many different insulin pumps available on the market, there are typically two kinds of pumps you can get. Pumps are recommended for children under 12 when multiple daily insulin injections aren’t practical or appropriate. With tube insulin pumps cost less than tubeless or implanted pumps. A single pump cost about $5,500 dollars already, while the supplies cost about $100 monthly. Abstract Importance: Insulin pump therapy may improve metabolic control in young patients with type 1 diabetes, but the association with short-term diabetes complications is unclear. The Swedish Association of Local Authorities and Regions funds the NDR. Supplementary Table 7 shows results by three alternative model specifications. 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. However, real-world data on health care and societal costs of insulin pump therapy compared with MDI therapy are scarce. designed and conducted the matching of study cohorts. Nurs Manage. 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. However, the time frame may need to be even longer to detect differences in treatment effects that have consequences for total costs exceeding those in this study. Talk to your health care provider about your diabetes management plan, including diet and exercise. The account is genuine, typical and documented. We had 73,920 person-years of observation with a mean follow-up of 5 years per participant. Health care costs are higher for Swedish adults with type 1 diabetes who use insulin pump therapy compared with those who use multiple daily injections, according to findings published in Diabetes Care. 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. The question was about whether it is necessary to use an insulin pump, or if multiple daily injections, either though a pen or syringe is better for diabetic? Between 1,000 and 1,500 new individuals were entered yearly in the NDR in 2002–2012. Data from the Swedish National Diabetes Register (NDR) have shown a lower incidence of some cardiovascular events and all-cause mortality for individuals with type 1 diabetes on insulin pump therapy in 2005–2012 (5). Regression analyses controlling for demographic and socioeconomic factors underscored the robustness of results on cost differences related to pump therapy. 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). The difference in the annual total cost between the therapy groups was $3,923 (95% CI $3,703–$4,143). Above costs are unique to insulin pump therapy vs multiple daily injections. Now, with the pump, it’s one injection every 3 days. 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%). Subgroup analyses by age indicated that the value of improved prevention may take time to manifest. Insulin via subcutaneous injection delivers insulin … Introduction: Fasting Ramadan carries a high risk for patients with type 1 diabetes (T1DM). DRG Statistics 2014—A Description of Healthcare Consumption in Sweden. A.-M.S. Total costs were higher for women but decreased with years of education and disposable income. 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. Before I was on the pump I would give about 10 injections a day (including my long-acting insulin). This pump uses a tube to connect the pump to the cannula. References. Explanatory variables included an indicator for insulin treatment therapy, demographics (sex, marital status), and socioeconomic characteristics (logarithm of disposable income, level of education). Clinically, insulin pens show an advantage through i … A: By sex, age, and diabetes duration in year of observation. Roze et al. and K.S.C. S.F. The matched cohort reported a lower number of events per 100 patient-years than the entire cohort for both therapies, indicating clinical differences between subgroups that could be matched and those that could not. The study cohort was young (mean baseline age 34 years) with relatively few diabetic complications in both study groups. DESIGN Pragmatic, multicentre, open label, parallel group, randomised controlled trial and economic evaluation. At baseline, the proportion of previous cardiovascular disease in the NDR study (5) was 5% versus 8% of the pump versus MDI groups, respectively, whereas it was ∼2.5% in both groups of the current study. Benefits of insulin pumps Insulin pumps: Cannulas are put into the skin every few days Injections: Injections are needed […] Multiple Daily Injections vs Insulin Pumps Some people with type 1 diabetes will be offered the choice of staying on multiple daily injections or starting on an insulin pump. The cost of insulin pumps is often between £2000 and £3000. The Supplementary Data presents additional panel data regressions on the risk of at least some inpatient care, sickness episodes, and use of unemployment benefits. For low-dose patients, injections were less expensive than pumps, with the former costing $9,172 for four years versus $14,994 for the latter. Health care costs, including medications and disposables, accounted for 73% of the costs for pump therapy and 63% of the costs for MDI therapy. No other potential conflicts of interest relevant to this article were reported. In principle, optimal glycemic control may be achieved by either MDI or insulin pump therapy. This subgroup had a slightly younger mean age and mean diabetes duration when entering the cost analysis than the cohort for the main analysis. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Integrated Database for Labor Market Research. Cost & Reputed Branded Insulin Pump. Whether or not we use an insulin pump or MDI, we all need to adjust our rapid-acting insulin if we want to exercise or move around without going low. Descriptive statistics of preindex date individual, clinical, disease, and socioeconomic characteristics. Gothenburg, Sweden, Centre of Registers Västra Götaland, 2016, Swedish National Board of Health and Welfare. We found lower rates of events in our adult population than the German-Austrian study (14). This cohort contained the highest number of individuals. 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) . The number of events related to kidney disease was driven by a few individuals with manifest kidney disease and frequent appointments. The oldest age-group in this study experienced diabetes onset in the 1960s–1980s, when treatment options differed from today’s standard care. Observational studies provide a better indication of what is achieved in daily medical practice than randomized controlled studies (12). With tube insulin pumps cost around $4000-$5000 each, while tubeless pumps cost around $6000-$7000 each. 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]). 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. The first kind is a traditional insulin pump. 1A and B). Supplementary Fig. It really depends where you live! 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. If you have an insulin pump on the NHS, you may need to cover some of the costs which may include insurance, accessories and, in the case of some pumps, glucose sensors as well. A total of 748 individuals switched from MDI to pump therapy after inclusion as a control subject and contributed data in each group. Costs in dollars were calculated using $1 = 6.514 SEK (annual exchange rate for 2013 from the Swedish Central Bank). Differences in these Swedish data were greater than previous cost-effectiveness analyses would indicate, but recent structural changes that include decentralized procurement of insulin pumps and disposables suggest that current expected costs reflect those of previous cost-effectiveness studies. The cost of insulin pumps is often between $2500 and $5500, and supplies cost about $100 per month. Years for which individuals had no available data in population registers, for instance, because of migration, were excluded together with those of matched control subjects, unless the control subject had switched to pump therapy and thus had been censored as a control. Further description of the matching strategy is provided in the Supplementary Data. The register includes risk factors, diabetic complications, and medications. As outrage over rising drug prices continues to mount, prices for insulin have seen a small decline. Since an insulin pump is delivering rapid-acting insulin all the time, you most likely will have too much insulin in your system for any type of spontaneous movement the majority of the time. No tedious technical management. We had 73,920 person-years of observation with a mean follow-up of 5 years per subject. Toresson Grip E, et al. “In principle, optimal glycemic control may be achieved by either [multiple daily injection] or insulin pump therapy,” Katarina Steen Carlsson, PhD, of the department of clinical sciences at University in Sweden, and colleagues wrote. CONCLUSIONS Nine years of real-world data on all measurable diabetes-related resource use show robust results for additional costs of insulin pump therapy in adults by subgroup and alternative propensity score specifications. The indication for insulin pump is broad with no out-of-pocket expenses for the patient. 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 controls are located on the pump, which is kept in your pocket. Social insurance payments underestimate the value of lost production because they are subject to floor and ceiling effects and are lower than wages. Without insurance, a new insulin pump costs about $6,000 out of pocket, plus another $3,000 to $6,000 annually for ongoing supplies, like batteries and sensors. y, years. Regression analyses showed higher costs for low education, low disposable income, women, and older age. With an insulin pump, it’s harder to hide. Thank you for your interest in spreading the word about Diabetes Care. AIMS: To estimate the cost effectiveness of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) for patients using insulin pumps. Therefore there should be no economical hindrance for the patient to be treated with insulin pump. Of the total cohort, 4,991 used insulin pump therapy (mean age, 33.8 years; 51.1% women). 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. Supplementary Figure 2A–C shows the distribution of age, diabetes duration, and HbA1c level at baseline (index date). Cost of medications and disposables by Swedish pharmacy official retail prices were taken from the Swedish Prescribed Drug Register. Total annual costs increased with age for both insulin therapies, and pump therapy was associated with higher costs across age-groups. Subgroup analyses revealed expected and substantial differences in average annual costs by diabetes duration and age (Fig. Riley D, Raup G. Impact of a subcutaneous injection device on improving patient care. Published models have identified change in HbA1c and reduction in number of hypoglycemic events as important drivers of costs. This pump uses a tube to connect the pump to the cannula. Insulin pump costs . 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