Insulin Pump Therapy Inferior to Insulin Injections in Cost-Effectiveness

Continuous subcutaneous insulin infusion (CSII) is associated with increased hypoglycemia encounters and health care expenditures, according to research published in the American Journal of Managed Care (June 21, 2017;23[6]).

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CSII—commonly referred to as insulin pump therapy—is an alternative to multiple daily insulin injections (MDII) for diabetes management. Prior research has reported some potential advantages of CSII over MDII therapy, such as reduced pain, less stigma, lower frequency of hypoglycemia, and overcoming adherence barriers. Limited data exists regarding whether the higher upfront costs for CSII can be offset by health improvements that translate to higher quality of life and lower utilization of health care services.

Ronald T Ackermann, MD, MPH, Northwestern Medicine (Chicago, IL), and colleagues conducted a study to evaluate patterns of health care utilization, costs, and blood glucose control for patients with diabetes who initiate CSII. Researchers sampled commercially insured patients (aged 18-64 years) with insulin-requiring diabetes who transitioned from MDII to CSII (n = 2539) or who continued using MDII (n = 2539) between 2009 and 2012. Medical claims and laboratory results files were used to estimate direct medical expenditures, hospital use, health care encounters with hypoglycemia, and mean concentration of glycated hemoglobin.

Over a 3-year span, men per-person total health care expenditures were $1714 (95% CI, $1184-$2244) higher for CSII initiators compared with matched MDII patients, equating to a total 3-year mean difference of approximately $20,565 per person. Mean glycated hemoglobin concentrations were lower for CSII initiators by only 0.46% after two years (P = .0003) and by 0.32% after three years (P = .047).

Additionally, CSII initiators demonstrated a higher rate of hypoglycemia encounters after 12 months (P = .002). 

Researchers concluded that adults with diabetes who transition from MDII to CSII are likely to receive modest improvements in glycated hemoglobin concentration, but accompanied with more hypoglycemia encounters and increased health care expenditures. These occurrences will likely happen without significant improvement in other potentially offsetting areas of health care consumption, they assert.

“It may remain challenging for health payers or providers to develop policies regarding access or coverage for CSII when, in aggregate, CSII appears to add immediate costs with short-term benefits that are uncertain and/or are difficult to measure,” researchers wrote.—Zachary Bessette