Authors' recommendations: This information brief is intended to inform the ministère de la Santé et des Services sociaux (MSSS) concerning reimbursement for insulin pumps in the treatment of type 1 diabetes. After the launch of the Insulin Pump Access Program in 2011, the MSSS asked to be updated on the state of the evidence on these medical instruments that deliver continuous subcutaneous insulin infusion. In particular, the MSSS wanted to know about the effectiveness of insulin pumps for the pediatric and adult populations in relation to the most common treatment modality: multiple daily insulin injections with a syringe or pen. A literature review was therefore performed on the clinical effectiveness of insulin pumps (excluding, in particular, the concept of quality of life), on economic aspects and on the medical eligibility criteria for public funding for insulin pumps. Funding programs for insulin pumps implemented in the other Canadian provinces and territories were also examined and the main criteria they use are listed. Examples include the age of the person with type 1 diabetes and the frequency of hypoglycemia and ketoacidosis events. Generally, the studies comparing the effectiveness of multiple insulin injections and continuous subcutaneous insulin infusion delivered by pumps presented results • that did not differ statistically between these two treatment modalities; • for which the statistical significance was not specified; or • that were contradictory across the studies. While it is true that statistically significant improvements were obtained with insulin pumps in relation to certain parameters, such as glycosylated hemoglobin rate, this finding nevertheless needs to be qualified. In fact, the number of studies analyzed was low, the study populations were heterogeneous, in addition to being small in number, and the study periods were relatively short. Even though the difference in effectiveness between insulin pumps and multiple injections was statistically significant, it is also important to state that it was not necessarily clinically significant. In fact, in the majority of the cases in which clinical significance was assessed, the results were not clinically significant. In the same vein, the review of the economic literature showed that the evidence was weak. In fact, only two assessment reports were selected and the authors of both indicated that the studies analyzed had methodological weaknesses.

Project Status: Completed

Year Published: 2015

URL for published report: http://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/MaladiesChroniques/INESSS_Pompesinsuline.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: ©Gouvernement du Québec/Institut national d'excellence en santé et en services sociaux