Cost‐effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections of insulin in Type 1 diabetes: a systematic review
Abstract
Aim Continuous subcutaneous insulin infusion (CSII) is increasingly used in clinical practice for the management of selected patients with Type 1 diabetes. Several cost-effectiveness studies comparing CSII vs. multiple insulin injections (MDI) have been reported. The aim was systematically to review these analyses and test the hypothesis that CSII is a cost-effective use of healthcare resources across settings. Methods A literature review was performed using MEDLINE, Cochrane Library and other databases. No time limit or language restrictions were applied. After two rounds of screening, 11 cost-effectiveness analyses were included in the final review, of which nine used the CORE Diabetes Model. A narrative synthesis was conducted and mean cost effectiveness calculated. Results CSII was considered cost-effective vs. MDI in Type 1 diabetes in all 11 studies in 8 countries, with a mean (95% CI) incremental cost effectiveness ratio of €30 862 (17 997-43 727), US$40 143 (23 409-56 876) per quality-adjusted life year (QALY) gained. CSII was associated with improved life expectancy and quality-adjusted life expectancy (0.4-1.1 QALYs in adults), driven by lower HbA(1c) and lower frequency of hypoglycaemic events vs. MDI. CSII was associated with higher lifetime direct costs due to higher treatment costs but this was partially offset by cost-savings from reduced diabetes-related complications. Conclusions Published cost-effectiveness analyses show that in Type 1 diabetes CSII is cost-…
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Economic analyses generally support the cost-effectiveness of diabetes technologies owing to a reduction in hypoglycaemia and acute and chronic diabetes complications.
“While these technologies are expensive, economic analyses generally support their cost‐effectiveness owing to a reduction in hypoglycaemia and acute and chronic diabetes complications.”
Insulin pump therapy and CGM reduce HbA1c, hypoglycaemia, diabetes burden and distress, and are associated with higher quality of life compared to usual care.
“Insulin pump therapy and continuous glucose monitor (CGM) reduce Haemoglobin A1c (HbA1c), hypoglycaemia, diabetes burden and distress, and are associated with higher quality of life (QOL) compared to usual care.”
Previous studies demonstrate glycaemic benefits for CGM and insulin pump.
“HbA1c was lower among CGM and insulin pump users in the BETTER Registry, which is consistent with previous studies demonstrating glycaemic benefits for these technologies.”
Cites
Insulin-pump therapy for type 1 diabetes mellitus
Pickup, J. C. (2012) · New England Journal of Medicine · doi:10.1056/nejmct1113948 · Cited by 270 · see citing works
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Advances in technology for management of type 1 diabetes
Beck, R. W., Bergenstal, R. M., Laffel, L. M., & Pickup, J. C. (2019) · The Lancet · doi:10.1016/s0140-6736(19)31142-0 · Cited by 242 · see citing works
Self-citationHeller, S., White, D., Lee, E., Lawton, J., Pollard, D., Waugh, N., Amiel, S., Barnard, K., Beckwith, A., Brennan, A., et al. (2017) · Health Technology Assessment · doi:10.3310/hta21200 · Cited by 73 · see citing works
Khodabandehloo, P., Fakembe, P., Senga, J., Shulman, R., Lipscombe, L. L., Witteman, H. O., Banerjee, A., Presseau, J., Nakhla, M., Dogba, M. J., et al. (2025) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.16426 · Cited by 6 · see citing works
- Authors
- Roze, S., Smith‐Palmer, J., Valentine, W., de Portu, S., Nørgaard, K., & Pickup, J. C.
- Affiliations
- HEVA HEOR Lyon France
- Ossian Health Economics and Communications Basel Switzerland
- Medtronic International Sàrl Tolochenaz Switzerland
- Hvidovre Hospital (DK)
- Guy's Hospital (GB)
- Corresponding author
- Roze, S.
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2015-05-28
- Volume
- 32
- Issue
- 11
- Pages
- 1415-1424
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- OpenAlex
- W1901223980
- Cited by
- 77
- References
- 1
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 6 · 2023: 4 · 2022: 1 · 2021: 12 · 2020: 10 · 2019: 10 · 2018: 10 · 2017: 12 · 2016: 4 · 2015: 2
- FWCI
- 1.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Medtronic SARL
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- insulin pump therapy, multiple daily insulin injections, type 1 diabetes, cost-effectiveness, hypoglycemia, glycemic control, HbA1c, quality-adjusted life years, diabetes complications, CORE Diabetes Model
- MeSH terms
- Cost-Benefit Analysis, Diabetes Mellitus, Type 1, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemia, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Health Care Costs, Quality-Adjusted Life Years, Evidence-Based Medicine, Diabetes Complications
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