Cost-effectiveness Analysis of Continuous subcutaneous insulin infusion compared with multiple daily injections in adult patients with type 1 and type 2 Diabetes mellitus: a systematic review

Abstract

Background: Insulin replacement therapy is the cornerstone for the treatment of type 1 and 2 diabetes mellitus. Two of the most used methods are continuous subcutaneous insulin infusion and multiple daily injections. This systematic review aims to find, can the continuous subcutaneous insulin infusion be considered cost-effective compared to the multiple daily injections? Methods: A systematic search was conducted in August 2021 that focused on the published literature comparing the cost-effectiveness of continuous subcutaneous insulin infusion with multiple daily injections. Searched databases included Pubmed, Scopus, Cochrane, and UPF finder. Results: A total of 621 publications were identified, of which 21 were analyzed. Results were significantly dependant on the study design and method used. Most of the studies based on Modelling reported that continuous subcutaneous insulin infusion is considered cost-effective compared to multiple daily injections with an average Incremental cost effectiveness ratio of US $37,717/QALY gained, with an Adjusted Incremental cost effectiveness ratio (to the year 2021) calculated as US $51,016/QALY gained. However, Randomized-controlled trials reported opposite results. Conclusion: Continuous subcutaneous insulin infusion is proven cost-effective compared to Multiple daily injections, especially in patients with high mean HbA1C, and can thus be considered a valuable therapy option in adult patients with type 1 diabetes mellitus. More evidence is needed in patients with type 2 diabetes mellitus treatment, but it would most probably be cost-effective, especially in patients with difficulty reaching optimal HbA1C levels using Multiple daily injections.