OBJECTIVES: To estimate the Incremental Cost-Effectiveness Ratio (ICER) of the use of continuous subcutaneous insulin infusion therapy (CSII) versus daily multiple injection therapy MDI in patients with type 1 diabetes at the Mexican Institute of Social Security (IMSS).

METHODS: An analytical model was developed using the internationally validated "IQVIA Core Diabetes Model", with which the incidence and progression of acute and chronic complications and the mortality of type 1 diabetes (T1D) was simulated throughout life. The basal characteristics of the simulated cohorts were obtained through review of clinical files, and through direct interviews with T1D patients aged 20 years and older served in two national medical centers of the IMSS during 2016. The costs of the complications and treatment of the disease with both therapies were estimated in Mexican pesos from the perspective of the institution using Diagnosis Related Groups for outpatient and inpatient care. The utilities were taken from international bibliography. Additionally, costs for early sickness pension were estimated. For the base case, a discount rate of 5% was applied for health outcomes and costs.

RESULTS: The average age of the cohort was 32 years, with a diabetes duration of 19 years, an average of 9.23% HbA1c; 29% were men. A gain of 0.614 Quality Adjusted Life Years (QALY) was estimated with the use of the CSII therapy. The estimated ICER, including only direct costs, was 478,020 MXN per QALY. The sensitivity analysis showed that in patients with HbA1c> 9.0% the ICER is of 262,237 MXN and of 369,593 MXN when the indirect costs are considered.

CONCLUSIONS: This is the first economic evaluation study that compares CSII versus MDI for T1D in Mexico. The insulin pump therapy is considered Cost-Effective in the context of the IMSS when patients have an A1c higher than 9.0%.