OBJECTIVES : Type 1 diabetes mellitus (T1DM) affects about 20 million people worldwide and this number continues to increase annually. Innovations in insulin delivery and glucose monitoring are designed to improve glycemic control and quality of life (QOL). These advances include continuous subcutaneous insulin infusion (CSII) and real-time continuous glucose monitoring (rt-CGM) sensor called sensor-augmented pump (SAP). The aim of the study had to evaluate the cost-effectiveness of continuous subcutaneous insulin infusion (CSII) compared with sensor-augmented pump (SAP) in T1DM in the Russian Federation.

METHODS : A Markov model with 15 year time horizon was developed. To calculate quality adjusted life years (QALY) for the entire simulation period, utility weights for each condition in which the patient stayed during a certain period were used. The number of complications on the CSII and SAP systems doesn’t differ significantly. Using SAP increases utility by 0.06. Direct costs included the cost of treatment the complications of T1DM, insulin pump, CGM sensor, transmitter, glucometer, test-trips, the ultrashort insulin, infusion sets, and reservoirs. Indirect costs included: loss of gross domestic product due to premature mortality, disability pension. Discount rate 5%. The exchange rate used $ 1 = 62 RUB.

RESULTS : The use of therapy with SAP resulted in a higher QALY value of 10.24 years compared with CSII 9.45 years. The total costs of during SAP treatment for one average patient was $ 6 847 per year, during CSII treatment $ 2 772 per year. The cost-effectiveness ratio (CER) of SAP was $ 5 228, CSII was $ 1 953. The ICER was $ 37 116/QALY above the recognised willingness to pay threshold of $ 34 209.

CONCLUSIONS : This analysis showed that SAP therapy is more QALY than CSII and have ICER above willingness to pay threshold. However, the Russian Federation's Ministry of Health reimburses SAP, despite the high cost.