COST – EFFECTIVENESS OF INSULIN PUMP THERAPY IN CHILDREN WITH TYPE I DIABETES IN KAZAKHSTAN

Purpose: We projected long-term costs and outcomes of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) in children aged 5-15 years with Type 1 diabetes. Within this project the Government of Kazakhstan provides children suffering from diabetes Type 1 by insulin pumps and expendables.

Method: We used IMS CORE Diabetes Model, an existing peer-reviewed, validated model, employing the standard Markov/Monte Carlo simulation to describe lifetime incidence and progression of diabetes. It was used to simulate disease progression in a cohort of patients with baseline characteristics taken from primary data collection (mean age 10.4 years, duration of diabetes 4.1 years, mean HbA1c >7.5%). We used the patient level data from the Kazakhstan National Register of diabetes for 2011-2012. Data costs are collected from database of treated impatient hospital cases, paid by the Guaranteed State Benefit Package.

Result: Mean undiscounted life expectancy of patients using CSII vs. MDI was increased by 3.58 years. The Incremental-Cost-Effectiveness-Ratio (ICER) for CSII was 3,935,375 KZT per Quality-Adjusted-Life-Year gained based on direct costs only (Table 1). When including indirect costs, the ICER decreased to 3’097’114 KZT/QALYg. CSII related therapy costs were partially offset by the savings due to the reduction in long-term complications, i.e. 638,744 KZT, mainly due to cardiovascular and renal diseases. Cumulative incidences of complications were also reduced (severe vision loss and end stage renal disease). Frequency of any complications of diabetes being delayed by an average of 3.6 years: ESRD - 3.9 years, blindness - 3.7 years, neuropathy - 3.4 years, amputation - 3.7 years, stroke - 3.5 years. Extensive sensitivity analyses showed the robustness of the results.

	QALE (years)	Direct costs (KZT)	ICER (KZT/QALYg)
MDI	13.34	4,459,297	-
CSII	14.56	9,225,694	-
Delta (CSII – MDI)	1.21	4,766,396	3,935,375

Conclusion: Using a payer’s perspective, our analysis showed that CSII is cost-effective over a lifetime horizon in children with Type 1 Diabetes (using a WTP threshold of 6,330,000 KZT [3x GDP]) and can lead to an increase in life expectancy as well as delay and reduce long-term complications. When including indirect costs, CSII would be even more attractive from a societal perspective.