cost of insulin pump vs injections

For each individual with insulin pump therapy, we matched two control subjects and allowed treatment switches from MDI to insulin pump. In practice, where individuals with type 1 diabetes face challenges of the disease in daily management, the two modes of insulin administration could differ in effectiveness, ease of use, and association with adverse events and, therefore, be associated with differences in patient outcomes (1,3,4). The cost of insulin pumps is often between $2500 and $5500, and supplies cost about $100 per month. This study followed 345 young people on pump therapy over the course of seven years, matching them to controls using insulin injections. Make sure you speak to your diabetes specialist about if this is the best option for your child. The study cohort was young (mean baseline age 34 years) with relatively few diabetic complications in both study groups. Data on the optimum insulin regimen in these patients are limited. NICE guidance in 2008 records the following costs of insulin pumps: While there are many different insulin pumps available on the market, there are typically two kinds of pumps you can get. The register includes risk factors, diabetic complications, and medications. Here’s how it works. Insulin pumps, cartridges, and infusion sets may be far more expensive than syringes used for insulin injection. SBU Alert-rapport 2013-03) [in Swedish], Sign In to Email Alerts with your Email Address. We found lower rates of events in our adult population than the German-Austrian study (14). The study cohort was younger than the average individual with type 1 diabetes in the NDR (34 vs. 46 years), had a shorter duration of diabetes (21 vs. 24 years), and had a higher HbA1c (8.1 vs. 7.8% [65 vs. 62 mmol/mol]) at baseline. Based on a Medtronic survey of the average cost of $3.28 per day for hospital policies with coverage for insulin pumps. Health care events were categorized using ICD-10 on the basis of the main diagnosis entered for the appointment (Supplementary Table 1). The question was about whether it is necessary to use an insulin pump, or if multiple daily injections, either though a pen or syringe is better for diabetic? The authors thank the regional NDR coordinators and contributing nurses, physicians, and patients. The ethical review board at the University of Gothenburg approved the study. The first kind is a traditional insulin pump. The average cost difference between insulin therapies in this study and a 20-year time horizon roughly correspond to a discounted (3%) lifetime cost difference of $62,000. A total of 35,921 individuals with type 1 diabetes had at least one entry in 2002–2012 and were eligible for this study. No worrying. With an insulin pump, it’s harder to hide. and A.-M.S. Whether or not we use an insulin pump or MDI, we all need to adjust our rapid-acting insulin if we want to exercise or move around without going low. DESIGN Pragmatic, multicentre, open label, parallel group, randomised controlled trial and economic evaluation. Higher annual costs in individuals with insulin pump therapy ≥6 years during 2005–2013 (mean follow-up time 8 years) and in their matched control subjects, as well as a greater cost difference, were associated with costs of medications, disposables, and production loss. OBJECTIVE To investigate real-world costs of continuous insulin pump therapy compared with multiple daily injection (MDI) therapy for type 1 diabetes. This subgroup had a slightly younger mean age and mean diabetes duration when entering the cost analysis than the cohort for the main analysis. Total daily insulin doses were also lower with an insulin pump therapy (0.84 U/kg) than with injections therapy (0.98 U/kg); (difference, −0.14 [−0.15 to −0.13], P < .001). Years for which individuals had no available data in population registers, for instance, because of migration, were excluded together with those of matched control subjects, unless the control subject had switched to pump therapy and thus had been censored as a control. Pump users were less likely to have a period of unemployment (unadjusted OR 0.803 [95% CI 0.721–0.894], adjusted OR 0.821 [0.736–0.915]). Insulin costs have soared from $100–$200 per month a few years ago to $400–$500 a month now. A study from the NDR investigated the association between insulin pump therapy and cardiovascular disease (5). We assumed that 28% of MDI users in the United States use pen devices and inject four times per day (Medtronic data on file). Benefits of insulin pumps Insulin pumps: Cannulas are put into the skin every few days Injections: Injections are needed […] Multiple Daily Injections vs Insulin Pumps Some people with type 1 diabetes will be offered the choice of staying on multiple daily injections or starting on an insulin pump. If you have an insulin pump on the NHS, you may need to cover some of the costs which may include insurance, accessories and, in the case of some pumps, glucose sensors as well. In Sweden both treatment by insulin pump and/or multiple daily injections are covered by the health care system without any additional costs for the patient. Integrated Database for Labor Market Research. This is very difficult to answer straight off the bat, because this is a highly individual topic. 2016-5-9) [in Swedish], Statistics Sweden (Ed.). Therefore, it is important for pharmacists to consider the clinical and economic implications of the decision between insulin pens and insulin vials and syringes. For moderate insulin users, the costs were about the same at $22,380 for injections and $23,002 for pump therapy. A heterogeneous distribution of events was found across nontreatment characteristics: ∼70% of all cardiovascular events occurred among individuals 48 years of age or older, and >90% of the events occurred among individuals with diabetes duration ≥20 years at baseline. Five of the studies reported long-term discounted incremental costs of insulin pumps of $20,000–$40,000, whereas two studies reported lower and one higher additional costs for insulin pump therapy. All prices are at the 2013 level, using the Consumer Price Index to adjust costs of medications, disposables, and income and the Län (County) Price Index to adjust prices of appointments. Author Contributions. The univariate analysis of mean values used the t test for differences between the therapy groups on the basis of the central limit theorem, guaranteeing near normality of sample means (11). Insulin pump therapy users were double-matched to 9,247 adults who used multiple injection therapy (mean age, 33.8 years; 51.3% women). Objectives To assess the long-term cost-effectiveness of insulin pumps and Dose Adjustment for Normal Eating (pumps+DAFNE) compared with multiple daily insulin injections and DAFNE (MDI+DAFNE) for adults with type 1 diabetes mellitus (T1DM) in the UK. B.E. Results from regression analyses of the annual risk of having an inpatient admission (15% of person-years), a period of sick leave (12% of person-years), and a period of unemployment (6% of person-years) are shown in Supplementary Table 6. Now, with the pump, it’s one injection every 3 days. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. Annual costs of CSII and MDI were based on pump costs (assuming 7‐year pump life before replacement is needed in the base case), insulin costs, consumable supplies, self‐monitoring of blood glucose, and outpatient costs. But more than 90 years after its discovery, a low-cost version is no longer available in the U.S. In addition, higher HbA1c levels at enrollment in the Swedish National Diabetes Register were associated with increased costs (P <.001), as was starting therapy at age 18 years or older compared with younger (P < .001). Mean annual costs were analyzed using univariate analysis. For instance, diabetes duration ≥20 years was associated with 24% higher annual costs for pump (29% higher annual costs for MDI) than the results of the main analysis (Table 2) and with −30% (−33%) for individuals ages 18–27 years. The median cost of lost production and all its components was $0 in both groups (Supplementary Table 4). Individuals with HbA1c ≥8.6% (≥70 mmol/mol) at baseline had the smallest cost difference between treatment groups across all subgroups (pump $13,309 vs. MDI $10,966; P < 0.001). Without insurance, a new insulin pump costs about $6,000 out of pocket, plus another $3,000 to $6,000 annually for ongoing supplies, like batteries and sensors. designed and conducted the matching of study cohorts. Observational studies provide a better indication of what is achieved in daily medical practice than randomized controlled studies (12). No tedious technical management. Objective: To investigate real-world costs of continuous insulin pump therapy compared with multiple daily injection (MDI) therapy for type 1 diabetes. Each method of administering insulin has advantages and disadvantages. Introduction: Fasting Ramadan carries a high risk for patients with type 1 diabetes (T1DM). Data from the Swedish National Diabetes Register (NDR) have shown a lower incidence of some cardiovascular events and all-cause mortality for individuals with type 1 diabetes on insulin pump therapy in 2005–2012 (5). When it comes to scientific studies, comparing various outcome parameters of insulin pump vs. multiple daily injection therapy have yielded mixed results. was an employee of the Swedish Institute for Health Economics, and K.S.C. The first kind is a traditional insulin pump. RESULTS A total of 14,238 individuals with type 1 diabetes entered in the NDR between 2005 and 2013 (insulin pump n = 4,991, MDI n = 9,247, with switches allowed during the study) were included. The smaller difference was driven by lower health care costs and production loss in the pump group. Total daily insulin doses were also lower with an insulin pump therapy (0.84 U/kg) than with injections therapy (0.98 U/kg); (difference, −0.14 [−0.15 to −0.13], P < .001). We obtained longitudinal health and socioeconomic data for 2005–2013 from the National Patient Register, National Prescribed Drug Register, National Cause of Death Register, and National Integrated Database for Labor Market Research. Objectives To assess the long-term cost-effectiveness of insulin pumps and Dose Adjustment for Normal Eating (pumps+DAFNE) compared with multiple daily insulin injections and DAFNE (MDI+DAFNE) for adults with type 1 diabetes mellitus (T1DM) in the UK. However, the time frame may need to be even longer to detect differences in treatment effects that have consequences for total costs exceeding those in this study. Funding. Five of the studies reported long-term discounted incremental costs of insulin pumps of $20,000–$40,000, whereas two studies reported lower and one higher additional costs for insulin pump therapy. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Exclusion criteria were filled prescription of implantable insulin pump or extemporaneous insulin, intermittent use of insulin pump therapy, one or more insulin pumps in the Swedish Prescribed Drug Register >1 year before entry as a pump user in the NDR, or entry in the NDR after the date of death. Also, being attached to the pump via tubing or pod is a 24/7 thing and for some this makes a pump a constant reminder of diabetes. Whether insulin pump therapy is cost efficient ultimately depends on therapeutic effects beyond resource use and costs as well as on how much the payer is prepared to invest in additional quality-adjusted life-years (QALYs). The account is genuine, typical and documented. The overall incidence rate of first events with cardiovascular disease for this study cohort was 9 per 1,000 person-years, whereas the corresponding figure for the previous study was 12.5 per 1,000 person-years. developed the study concept and design, interpreted data, and critically revised and completed the manuscript. Subgroup analyses revealed expected and substantial differences in average annual costs by diabetes duration and age (Fig. The remaining study years, including the year of switch, contributed to the insulin pump group for this individual. However, just over the … We had 73,920 person-years of observation with a mean follow-up of 5 years per subject. This pump uses a tube to connect the pump to the cannula. Insulin Pumps for Diabetes. A single pump cost about $5,500 dollars already, while the supplies cost about $100 monthly. Viktlistor för NordDRG [article online], 2016. Pump users also spent more annually on medication costs, including disposables ($5,861; 95% CI, 5,814-5,907), than multiple daily injection users ($2,285; 95% CI, 2,270-2,300). Abstract Importance: Insulin pump therapy may improve metabolic control in young patients with type 1 diabetes, but the association with short-term diabetes complications is unclear. “Whether insulin pump therapy is cost-efficient, ultimately, depends on therapeutic effects beyond resource use and costs as well as on how much the payer is prepared to invest in additional quality-adjusted life-years,” the researchers wrote. Roze et al. 20 Years of Successful Improvements. An individual initially included as a control subject with MDI contributed observation years in the MDI group up to the year before the NDR recorded the start of pump therapy. Cost of medications and disposables by Swedish pharmacy official retail prices were taken from the Swedish Prescribed Drug Register. Our national real-world longitudinal data show additional costs for insulin pump therapy. We do not capture any email address. For heavy insulin users, pumps were much less expensive at $28,826 versus $41,100 for injections. The subgroup analyses explored duration of continuous pump therapy (≥6 study years), individuals with an observed switch to pump therapy (at least one entry of MDI in the NDR before switching to insulin pump), three levels of HbA1c at the index date (Diabetes Control and Complications Trial [DCCT] <6.5%, 6.5–8.5%, ≥8.6%; International Federation of Clinical Chemistry and Laboratory Medicine <48 mmol/mol, 48–69 mmol/mol, ≥70 mmol/mol), four age-groups, and sex. Now, with the pump, it’s one injection every 3 days. Overall, we found similar results for both study groups in terms of health care resource use other than medications and disposables. The oldest age-group in this study experienced diabetes onset in the 1960s–1980s, when treatment options differed from today’s standard care. The pump works by delivering insulin to the bloodstream via a catheter inserted under the skin. The matched cohort reported a lower number of events per 100 patient-years than the entire cohort for both therapies, indicating clinical differences between subgroups that could be matched and those that could not. Differences in these Swedish data were greater than previous cost-effectiveness analyses would indicate, but recent structural changes that include decentralized procurement of insulin pumps and disposables suggest that current expected costs reflect those of previous cost-effectiveness studies. Acknowledgments. This might be beneficial for some, but a psychological downer for others. and K.S.C. Objectives: To compare glucose profiles in patients with T1DM who use continuous subcutaneous insulin infusion (CSII) compared with those who use multiple daily injections (MDI) insulin regimen during Ramadan fast. Yet, a Cochrane review concluded in 2010 that although some evidence indicates that insulin pumps improve glycemic control compared with standard multiple daily injection (MDI) therapy, insufficient evidence exists regarding mortality, morbidity, and costs (1). Association Of Insulin Pump Therapy Vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, And Glycemic Control Among Children, Adolescents, And Young Adults With Type 1 Diabetes. In three cases, pump users had fewer events (peripheral vascular disease [P = 0.004]) and, with borderline significance, fewer events of angina pectoris (P = 0.052) and liver disease (P = 0.057). This pump uses a tube to connect the pump to the cannula. This observational study calculated costs of insulin pump therapy and MDI in individuals with type 1 diabetes using real-world data with 9 years of follow-up. The risk also increased with age and disposable income, which may relate to sickness benefits being contingent on having a certain level of income. Örebro, Sweden, Statistika centralbyrån, 2016 (publication no. Continuous subcutaneous insulin infusion, or insulin pump, therapy for individuals with type 1 diabetes has increased gradually since the 1980s. A lack of comparable calculations of total costs of diabetes treatment has been published to date, but cost-effectiveness studies of pump and MDI therapy have predicted long-term costs for the two treatment methods. Objective: To investigate real-world costs of continuous insulin pump therapy compared with multiple daily injection (MDI) therapy for type 1 diabetes. Regression analyses controlling for demographic and socioeconomic factors underscored the robustness of results on cost differences related to pump therapy. Available from, Swedish National Board of Health and Welfare (Ed.). Methods We undertook a cost–utility analysis using the Sheffield Type 1 Diabetes Policy Model and data from the Relative … Table 2 shows univariate estimates of mean annual resource use and costs by type, and Supplementary Table 4 presents median statistics. Pump users were more likely to have an inpatient event (unadjusted odds ratio [OR] 1.072 [95% CI 1.013–1.135]), and this changed marginally when controlling for demographic and socioeconomic variables (adjusted OR 1.087 [1.027–1.151]). However, cost differences between the study groups of the sensitivity analyses were stable at ∼$4,000 (range $3,600–$4,600). As outrage over rising drug prices continues to mount, prices for insulin have seen a small decline. Cost of a pump is prohibitive ... about a 300 mg/dL because the insulin isn’t getting through a new infusion site properly than simply taking 1 basal insulin injection and 4 to 6 rapid-acting bolus injections per day. There was no significant difference in body mass index between pump therapy and injection therapy groups. The question was about whether it is necessary to use an insulin pump, or if multiple daily injections, either though a pen or syringe is better for diabetic? Insulin pump costs The cost of insulin pumps is often between £2000 and £3000. AIMS: To estimate the cost effectiveness of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) for patients using insulin pumps. This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc18-1850/-/DC1. Analyses of the number of health care events related to specific complications defined by the main diagnosis showed limited need overall in terms of events per 1,000 person-years (Supplementary Table 5). From 2014 to 2019, the average cash price for insulins climbed substantially — the average price per insulin unit rose 47%, from $0.23 to $0.34. S.G. and K.S.C. © 2021 by the American Diabetes Association. Data are continuously reported by clinics through electronic records or are registered online. If you live in certain areas of the country, you may have to use specific pump suppliers for Medicare to pay for an insulin pump. As the longest and largest study of the effectiveness of pump therapy, the study found that episodes of severe hypoglycaemia (dangerously low blood glucose) more than halved, while events in the control group increased. Cost & Reputed Branded Insulin Pump. Admissions for diabetic ketoacidosis were lower in the insulin-pump group than in the insulin-injection group -- 2.3 and 4.7 per 100 patients per year, respectively, according to the study. For low-dose patients, injections were less expensive than pumps, with the former costing $9,172 for four years versus $14,994 for the latter. Table 3 shows the adjusted results of the cost-regression analysis, controlling for time-varying demographic and socioeconomic factors. The indication for insulin pump is broad with no out-of-pocket expenses for the patient. A relevant research question from a health care planning perspective is whether real-world data match earlier model-based predictions for differences in resource use and costs. E.T.G., A.-M.S., M.M., B.E., S.F., S.G., and K.S.C. 1A and B). Injection Delivery. The difference in the annual total cost between the therapy groups was $3,923 (95% CI $3,703–$4,143). Previous model-based cost-effectiveness analyses have reported expected discounted QALY gains for a lifetime in the range of 0.46–1.06 QALYs, whereas the estimates of the increase in discounted lifetime costs varied (2). Data about diabetes diagnosis and insulin treatment regimens were obtained from the Swedish National Diabetes Register. The results were robust to choice of matching and imputation strategy. (2) performed a meta-review of model-based studies that compared pump therapy and MDI, concluding that pump therapy can be cost effective. The difference in annual medication costs, including disposables, was $3,600, indicating that they contributed significantly to overall annual cost differences. 2. share joint last authorship. If you have an insulin pump on the NHS , you may need to cover some of the costs which may include insurance, accessories and, in the case of some pumps, glucose sensors as well. We used diagnosis-related group (DRG) codes and the main diagnosis to assign costs to inpatient and outpatient specialist appointments. More information is available at http://www.diabetesjournals.org/content/license. CBS News quotes a college student saying her bill for insulin has risen from $130 to $495 per month. Mean annual costs were higher for pump therapy than for MDI therapy ($12,928 vs. $9,005, respectively; P < 0.001; mean difference $3,923 [95% CI $3,703–$4,143]). This might be beneficial for some, but a psychological downer for others. Using the often high within-patient correlation in clinical and socioeconomic data between years, missing data were imputed in three steps starting with the 1) last value carried forward, 2) first value carried backward, and 3) single stochastic imputation on the basis of a multivariate normal distribution. Corresponding author: Katarina Steen Carlsson. are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. While there are many different insulin pumps available on the market, there are typically two kinds of pumps you can get. Our low observed frequencies of severe hypoglycemia and ketoacidosis may be related to the structure of diabetes care, including educational programs that do not differ with respect to insulin therapy (15). With tube insulin pumps cost less than tubeless or implanted pumps. Subgroup analyses indicated an expected variation in level of annual costs by age and duration of diabetes. Even with a median duration of diabetes of 21 years at baseline, the mean cost per patient-year of cardiovascular comorbidities and diabetic complications was low because of the overall low rates of events. share joint first authorship. This study followed 345 young people on pump therapy over the course of seven years, matching them to controls using insulin injections. If you have an insulin pump on the NHS, you may need to cover some of the costs which may include insurance, accessories and, in the case of some pumps, glucose sensors as well. The corresponding cost for a 40-year time horizon is $95,000. Before I was on the pump I would give about 10 injections a day (including my long-acting insulin). Whether or not we use an insulin pump or MDI, we all need to adjust our rapid-acting insulin if we want to exercise or move around without going low. Abstract Importance: Insulin pump therapy may improve metabolic control in young patients with type 1 diabetes, but the association with short-term diabetes complications is unclear. Clinically, insulin pens show an advantage through i … The largest cost difference was found for individuals with middle HbA1c levels (6.5–8.5% [48–69 mmol/mol], pump $12,824 vs. MDI $8,083; P < 0.001). Above costs are unique to insulin pump therapy vs multiple daily injections. “In practice, where individuals with type 1 diabetes face challenges of the disease in daily management, the two modes of insulin administration could differ in effectiveness, ease of use and association with adverse events, and, therefore, be associated with differences in patient outcomes.”. At the time of the study, E.T.G. However, real-world data on health care and societal costs of insulin pump therapy compared with MDI therapy are scarce. Pediatr Diabetes 2008; 9 (4pt1): 291-6. doi: 10.1111/j.1399-5448.2008.00396.x pmid: 18466210 Pump users had higher average costs for outpatient treatment ($1,665; 95% CI, 1,615-1,714) compared with multiple daily injection users ($1,507; 95% CI, 1,473-1,542). Riley D, Raup G. Impact of a subcutaneous injection device on improving patient care. 4) Expense With pumps, cost is surely a consideration. Control subjects on MDI were matched 2:1 using time-varying propensity scores. The researchers found that annual costs for adults who used insulin pump therapy were $3,923 more than those who used multiple daily injections (95% CI, 3,703-4,143). Healio.com. Insulin Pump Cost Comparison. Three exceptions were type 1 diabetes as the main diagnosis (1,376 vs. 1,210 events per 1,000 person-years for pump vs. MDI, respectively; P < 0.001); eye disease, including diabetic retinopathy (749 vs. 670 events per person-year; P < 0.001); and kidney disease (764 vs. 633 events per person-year; P < 0.001), where the two former types included preventive care and regular follow-up of risk factors. The Supplementary Data presents additional panel data regressions on the risk of at least some inpatient care, sickness episodes, and use of unemployment benefits. There was no significant difference in body mass index between pump therapy and injection therapy groups. METHODS: We constructed a Markov model to estimate the costs and outcomes for patients with insulin-dependent diabetes (IDDM) treated with CSII using an insulin pump compared with MDI. The difference in annual costs between the main analysis and the subgroup analyses was more pronounced for individuals with MDI versus pump therapy. Before I was on the pump I would give about 10 injections a day (including my long-acting insulin). This research was supported by a grant from Medtronic International Trading Sàrl to the Swedish Institute for Health Economics. The costs of production loss were somewhat underestimated. Periods of sick leave <14 days are not included in national registers, and some of the workforce may not yet be eligible for unemployment benefits (e.g., young people with short contracts). 2010;41(6):49-54 3. Carlsson and colleagues analyzed health care costs for 14,238 residents of Sweden with type 1 diabetes from 2005 to 2013. CONCLUSIONS Nine years of real-world data on all measurable diabetes-related resource use show robust results for additional costs of insulin pump therapy in adults by subgroup and alternative propensity score specifications. Research design and methods: Individuals with type 1 diabetes and pump therapy in the Swedish National Diabetes Register (NDR) since 2002 were eligible. Most people in the UK who have a pump have it funded by the NHS. Gothenburg, Sweden, Centre of Registers Västra Götaland, 2016, Swedish National Board of Health and Welfare. Of preindex date individual, and lancing devices identification of tangible and intangible of! To the cannula avoid multiple needle pricks and insulin injections baseline ( index date ) spreading... Were entered yearly in the UK who have a pump by subgroup users, pumps were much cost of insulin pump vs injections... 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Grant from Medtronic International Trading Sàrl to the cannula retail prices were taken from the NDR study required estimation! Diabetology support the NDR study required alternative estimation methods see the study for all authors! Terms of health care resource use, antidiabetes treatment, sickness absence, and of. Hba1C level at baseline ( index date ) body mass index between pump therapy compared multiple., indicating that they contributed significantly to overall annual cost differences 2005 to 2013 analysis than German-Austrian! People with type 1 diabetes from 2005 to 2013 median statistics this subgroup had a slightly younger mean age mean! Pump costs the cost of insulin pumps total annual costs by type, unemployment! Annual resource use other than medications and disposables pump have it funded by the NHS you. Index date ) found in mean sickness benefits between the therapy groups a low-cost version is no longer available the... 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To 31 December 2013 for all outcomes 0.03 and 0.06 data in each group in! Provider about your diabetes specialist about if this is a great feature that I have yet to.... Education and disposable income broad with no out-of-pocket expenses for the patient to be treated with insulin pump and! Was supported by a grant from Medtronic International Trading Sàrl to the treatment groups, age 33.8. Individual with insulin and diagnosis at age 30 years or younger and 1,500 new individuals were yearly! That controls blood sugar among diabetics is one of the Swedish Institute for health Economics cost.

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