OBJECTIVES: To project the long-term costs and outcomes of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) in children with Type 1 diabetes in KAZAKHSTAN. METHODS: The CORE Diabetes Model is a peer-reviewed, validated model, which employs standard Markov/Monte Carlo simulation techniques to describe the long-term incidence and progression of diabetes-related complications. It was used to simulate disease progression in a cohort of pediatric patients with baseline characteristics taken from published KAZAKHSTAN studies (mean age 10.4 years, duration of diabetes 4.1 years, mean HbA1c >7.5%).  Direct costs for 2013 were calculated from a third-party payer perspective. Discount rates of 5% per annum were applied to costs and 3% to clinical outcomes. RESULTS: 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 3,935,375KZT per Quality-Adjusted-Life-Year gained based on direct costs only. CSII related therapy costs were partially offset by the savings due to the reduction in long-term complications, i.e.638,744KZT, mainly due to cardiovascular and renal diseases. Cumulative incidences of proliferative diabetic retinopathy, blindness, ESRD, and GRP were decreased by 25.3%, 5.6%, 28.3%, and 17.7%, respectively. CSII treatment also delayed the average onset of ESRD (3.9 years), blindness (3.7 years), PVD (3.5 years), CHF (3.6 years), Neuropathy (3.4 years), first ulcer (4.0 years), amputation (3.7 years), MI (3.5 years), and stroke (3.5 years). Extensive sensitivity analyses showed the robustness of the results. CONCLUSIONS: Using a payer’s perspective, our analysis showed that CSII is cost-effective over a lifetime horizon in children with Type 1 Diabetes in Kazakhstan (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.