Authors' recommendations: The review conclusions are based on the current evidence available from this report’s critical appraisal of literature published since the NHS assessment report on the efficacy, safety, and cost-effectiveness of CSII compared with MDI. In general, the findings of the current review support the findings of the original NHS assessment report, that is, an improvement in glycaemic control that is of small magnitude and borderline statistical significance.When compared with optimised MDI, CSII results in a modest but potentially worthwhile improvement in glycosylated haemoglobin levels in all patient groups assessed (ie, adults with type 1 diabetes, children and adolescents with type 1 diabetes, and adults with type 2 diabetes). Due to the short duration of the clinical trials is not possible to evaluate the longer term benefits of such a difference in HbA1c levels; however, there is an expectation that it would be reflected in a reduction in long-term complications. Although more immediate primary benefits from CSII maybe associated with an impact on the incidence of severe hypoglycaemic events and improved quality of life (through greater flexibility of lifestyle), there is limited evidence to support this from the studies identified in this update. However, despite the limited evidence it is postulated that CSII may reduce the number of severe hypoglycaemic attacks a patient experiences compared with MDI. According to the results of the cost-effectiveness analysis conducted herein, it is estimated that if every patient who changed from MDI to CSII therapy was able to avoid one severe hypoglycaemic attack every two years (ie, an improvement of 0.5 events per annum), the incremental cost per severe hypoglycaemic event avoided would be approximately $6,000. The total incremental cost associated with the introduction of CSII compared to MDI for a patient with type 1 diabetes is approximately $16,000 over six years (the approximated life of the pump).

Project Status: Completed

URL for project: http://www.healthsac.net/downloads/publications/HSAC04%20Subcutaneous%20Insulin%20Pump%20270308.pdf

Year Published: 2008

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: New Zealand

Organisation Name: Health Services Assessment Collaboration

Contact Address: University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand

Contact Name: hsac@canterbury.ac.nz

Contact Email: hsac@canterbury.ac.nz

Copyright: Health Services Assessment Collaboration (HSAC)