Paediatric Endocrinology and Metabolism Department, Qingdao Women and Children's Hospital, Qingdao, China.
Neuroendocrine Pediatric Department, The Affiliated Hospital of Qingdao University, Qingdao, China.
Front Endocrinol (Lausanne). 2021 Mar 30;12:604028. doi: 10.3389/fendo.2021.604028. eCollection 2021.
To evaluate the clinical and economic consequences of continuous subcutaneous insulin infusion (CSII) vs. multiple daily injections (MDI) in children and adolescents with type 1 diabetes mellitus (T1DM) from a public health care system in developed areas of developing country, considering changes in glycemic Control, daily insulin requirements, lipid profile, body mass index (BMI), frequency of severe hypoglycemia and Diabetic Ketoacidosis (DKA) and diabetic complications.
This was a retrospective cohort study of children and adolescents with T1DM. Data were collected at baseline and the end of every year including glycated hemoglobin (HbA1c), insulin dose, lipid profile, blood pressure, and adverse events (severe hypoglycemia and DKA). The Cost-effectiveness analysis was performed using the IQVIA CORE Diabetes Model (CDM) to simulate diabetes progression by utilizing the clinical data obtained from the two groups. The main outcome measures were Life Expectancy, Quality adjusted life years (QALYs), Total Costs and Incremental Costs and Effectiveness Ratio (ICER) of CSII compared with MDI in Chinese pediatric patients with T1DM in Qingdao City (60 years).
Mean HbA1c values and daily insulin doses were significantly lower in those receiving CSII therapy throughout follow-up. Mean direct lifetime costs were ¥ 67,137 higher with CSII treatment than with MDI for pediatric patients. Treatment with CSII was associated with an improvement in life expectancy of 0.41 years for pediatric patients compared with MDI based on CORE diabetes model simulation. The corresponding gains in QALYs were 0.42. These data produced corresponding ICER is ¥ 161,815 per QALY for pediatric T1DM patients in Qingdao. Sensitivity analyses suggested that our base-case assumptions were mostly robust.
CSII is associated with improved long-term clinical outcomes compared with MDI. Based on this model analysis, CSII appears to be more cost-effective for the Qingdao TIDM pediatric population and health care system.
评估在发展中国家发达地区的公共医疗保健系统中，1 型糖尿病（T1DM）儿童和青少年使用连续皮下胰岛素输注（CSII）与多次皮下胰岛素注射（MDI）的临床和经济后果，同时考虑血糖控制、每日胰岛素需求、血脂谱、体重指数（BMI）、严重低血糖和糖尿病酮症酸中毒（DKA）以及糖尿病并发症的变化。
这是一项回顾性队列研究，纳入了 T1DM 儿童和青少年患者。数据在基线和每年末采集，包括糖化血红蛋白（HbA1c）、胰岛素剂量、血脂谱、血压和不良事件（严重低血糖和 DKA）。使用 IQVIA CORE Diabetes Model（CDM）进行成本效果分析，利用两组的临床数据模拟糖尿病进展。主要结局指标是 CSII 与 MDI 相比在青岛 T1DM 中国儿科患者中的预期寿命、质量调整生命年（QALYs）、总费用和增量成本效果比（ICER）。
在整个随访期间，接受 CSII 治疗的患者的平均 HbA1c 值和每日胰岛素剂量明显更低。与 MDI 相比，CSII 治疗的儿童患者终生直接费用平均高出 ¥67137。基于 CORE 糖尿病模型模拟，CSII 治疗与 MDI 相比可使儿科患者的预期寿命延长 0.41 年。相应的 QALY 增益为 0.42。这些数据产生了相应的 ICER，对于青岛的 T1DM 儿科患者为 ¥161815 每 QALY。敏感性分析表明，我们的基本假设大多是稳健的。
与 MDI 相比，CSII 与改善的长期临床结局相关。基于该模型分析，CSII 对青岛 TIDM 儿科人群和医疗保健系统似乎更具成本效益。
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