OBJECTIVES : Continuous subcutaneous insulin infusion (CSII) in patients with type 2 diabetes (T2DM) improves glycemic control (HbA1c) and reduces insulin dosage compared to multiple daily injections (MDI). However, CSII has not been widely adopted in T2DM due to costs, complexity and training requirements. New delivery devices, like PAQ^®, an uncomplicated 3-day insulin delivery device (CeQur Corporation, Marlborough, MA) provide simple insulin infusion (SII) as an alternative to traditional CSII. This analysis investigated the cost-effectiveness of SII vs. MDI in US patients with T2DM not in glycemic control, with the objective to assess the value of SII devices using a pragmatic methodology.

METHODS : Traditional and established T2DM models to predict disease progression and cost-effectiveness are complex and uncomprehensive. Assuming similar efficacy of CSII and SII, we adopted a simplified pragmatic methodology using recently published data on the relationship between baseline HbA1c levels and effect of treatment with CSII versus MDI on HbA1c (Pickup et al 2017); between change in HbA1c and quality-adjusted life years (QALYs) along with life expectancy (Hua et al 2017); between change in HbA1c and effect on complications (Fortwaengler et al 2017). Insulin doses were based on data from the OpT2mise study (Reznik et al 2014). Costs and outcomes were discounted at 3%.

RESULTS : Incremental cost-effectiveness ratios of costs per QALY gained below 1xGDP per capita (2016: USD 57,467) were defined as ‘highly cost-effective’ and below 3xGDP as ‘cost-effective’. Base-case results indicated that a SII device is cost-effective in a price range around $13 to $19 per patient per day, depending on baseline HbA1c value and the cost-effectiveness threshold used.

CONCLUSIONS : Pragmatic methods may be useful to evaluate cost-effectiveness of treatment alternatives in T2DM, allowing transparency and flexibility. SII has potential to become a highly cost-effective treatment alternative in patients with T2DM on MDI not in glycemic control.