Pollard Daniel John, Brennan Alan, Dixon Simon, Waugh Norman, Elliott Jackie, Heller Simon, Lee Ellen, Campbell Michael, Basarir Hasan, White David
School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
Population Evidence and Technologies, Warwick Medical School, University of Warwick, Coventry, UK.
BMJ Open. 2018 Apr 7;8(4):e016766. doi: 10.1136/bmjopen-2017-016766.
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.
We undertook a cost-utility analysis using the Sheffield Type 1 Diabetes Policy Model and data from the Relative Effectiveness of Pumps over Structured Education (REPOSE) trial to estimate the lifetime incidence of diabetic complications, intervention-based resource use and associated effects on costs and quality-adjusted life years (QALYs). All economic analyses took a National Health Service and personal social services perspective and discounted costs and QALYs at 3.5% per annum. A probabilistic sensitivity analysis was performed on the base case. Further uncertainties in the cost of pumps and the evidence used to inform the model were explored using scenario analyses.
Eight diabetes centres in England and Scotland.
Adults with T1DM who were eligible to receive a structured education course and did not have a strong clinical indication or a preference for a pump.
Pumps+DAFNE.
MDI+DAFNE.
Incremental costs, incremental QALYs gained and incremental cost-effectiveness ratios (ICERs).
Compared with MDI+DAFNE, pumps+DAFNE was associated with an incremental discounted lifetime cost of +£18 853 (95% CI £6175 to £31 645) and a gain in discounted lifetime QALYs of +0.13 (95% CI -0.70 to +0.96). The base case mean ICER was £142 195 per QALY gained. The probability of pump+DAFNE being cost-effective using a cost-effectiveness threshold of £20 000 per QALY gained was 14.0%. All scenario and subgroup analyses examined indicated that the ICER was unlikely to fall below £30 000 per QALY gained.
Our analysis of the REPOSE data suggests that routine use of pumps in adults without an immediate clinical need for a pump, as identified by National Institute for Health and Care Excellence, would not be cost-effective.
ISRCTN61215213.
评估胰岛素泵与正常饮食剂量调整法（胰岛素泵+DAFNE）相比，每日多次胰岛素注射与DAFNE（MDI+DAFNE）用于英国1型糖尿病（T1DM）成人患者的长期成本效益。
我们使用谢菲尔德1型糖尿病政策模型和来自胰岛素泵与结构化教育相对有效性（REPOSE）试验的数据进行成本效用分析，以估计糖尿病并发症的终生发病率、基于干预的资源使用情况以及对成本和质量调整生命年（QALYs）的相关影响。所有经济分析均从英国国家医疗服务体系和个人社会服务的角度进行，并按每年3.5%的贴现率对成本和QALYs进行贴现。对基础病例进行了概率敏感性分析。使用情景分析探讨了胰岛素泵成本和用于为模型提供信息的证据中的进一步不确定性。
英格兰和苏格兰的8个糖尿病中心。
符合接受结构化教育课程条件且没有强烈临床指征或对胰岛素泵无偏好的T1DM成人患者。
胰岛素泵+DAFNE。
MDI+DAFNE。
增量成本、获得的增量QALYs和增量成本效益比（ICERs）。
与MDI+DAFNE相比，胰岛素泵+DAFNE的增量贴现终生成本为+18853英镑（95%置信区间6175英镑至31645英镑），贴现终生QALYs增加0.13（95%置信区间-0.70至+0.96）。基础病例的平均ICER为每获得一个QALY 142195英镑。使用每获得一个QALY 20000英镑的成本效益阈值，胰岛素泵+DAFNE具有成本效益的概率为14.0%。所检查的所有情景和亚组分析均表明，ICER不太可能降至每获得一个QALY 30000英镑以下。
我们对REPOSE数据的分析表明，按照英国国家卫生与临床优化研究所的定义，对无迫切临床需求的成人常规使用胰岛素泵不具有成本效益。
ISRCTN61215213。
