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Observational Study
. 2021 Mar 30:12:604028.
doi: 10.3389/fendo.2021.604028. eCollection 2021.

Clinical Outcome and Cost-Effectiveness Analysis of CSII Versus MDI in Children and Adolescent With Type 1 Diabetes Mellitus in a Public Health Care System of China

Sicui Hu  1 , Hongxiu Yang  1 , Zhihong Chen  2 , Xuefei Leng  2 , Cheng Li  1 , Lingyan Qiao  1 , Weiqing Lv  3 , Tang Li  1
Affiliations
Observational Study

Clinical Outcome and Cost-Effectiveness Analysis of CSII Versus MDI in Children and Adolescent With Type 1 Diabetes Mellitus in a Public Health Care System of China

Sicui Hu et al. Front Endocrinol (Lausanne). .

Abstract

Objectives: To evaluate the clinical and economic consequences of continuous subcutaneous insulin infusion (CSII) vs. multiple daily injections (MDI) in children and adolescents with type 1 diabetes mellitus (T1DM) from a public health care system in developed areas of developing country, considering changes in glycemic Control, daily insulin requirements, lipid profile, body mass index (BMI), frequency of severe hypoglycemia and Diabetic Ketoacidosis (DKA) and diabetic complications.

Methods: This was a retrospective cohort study of children and adolescents with T1DM. Data were collected at baseline and the end of every year including glycated hemoglobin (HbA1c), insulin dose, lipid profile, blood pressure, and adverse events (severe hypoglycemia and DKA). The Cost-effectiveness analysis was performed using the IQVIA CORE Diabetes Model (CDM) to simulate diabetes progression by utilizing the clinical data obtained from the two groups. The main outcome measures were Life Expectancy, Quality adjusted life years (QALYs), Total Costs and Incremental Costs and Effectiveness Ratio (ICER) of CSII compared with MDI in Chinese pediatric patients with T1DM in Qingdao City (60 years).

Results: Mean HbA1c values and daily insulin doses were significantly lower in those receiving CSII therapy throughout follow-up. Mean direct lifetime costs were ¥ 67,137 higher with CSII treatment than with MDI for pediatric patients. Treatment with CSII was associated with an improvement in life expectancy of 0.41 years for pediatric patients compared with MDI based on CORE diabetes model simulation. The corresponding gains in QALYs were 0.42. These data produced corresponding ICER is ¥ 161,815 per QALY for pediatric T1DM patients in Qingdao. Sensitivity analyses suggested that our base-case assumptions were mostly robust.

Conclusions: CSII is associated with improved long-term clinical outcomes compared with MDI. Based on this model analysis, CSII appears to be more cost-effective for the Qingdao TIDM pediatric population and health care system.

Keywords: continuous subcutaneous insulin infusion; cost-effectiveness analysis; glycated hemoglobin; incremental costs and effectiveness ratio; multiple daily injections; quality adjusted life years; type 1 diabetes mellitus.

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Conflict of interest statement

Author WL was employed by Medtronic (Shanghai) Management Co, Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Percentage of children who reached the target of HbA1c <7.5% at different time points during the 4-year follow-up. Follow-up (years).
Figure 2
Figure 2
Daily insulin requirement changes in both CSII and MDI groups.
Figure 3
Figure 3
Incremental cost effect scatter diagram.
Figure 4
Figure 4
Cost effect acceptability curve.
Figure 5
Figure 5
Time alive and free of complication (in years).
See this image and copyright information in PMC

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References

    1. Zhao ZH, Sun CJ, Wang CF, Li P, Wang W, Ye J, et al. . Rapidly rising incidence of childhood type 1 diabetes in Chinese population: epidemiology in Shanghai during 1997-2011. Acta Diabetol (2014) 6:947–53. 10.1007/s00592-014-0590-2 - DOI - PubMed
    1. Wu HB, Zhong JW, Hu RY, Wang H, Gong WW, Pan J, et al. . Rapidly rising incidence of Type 1 diabetes in children and adolescents aged 0-19 years in Zhejiang, China, 2007 to 2013. Diabetes Med (2016) 10:1339–46. 10.1111/dme.13010 - DOI - PubMed
    1. Subspecialty Group of Endocrinologic. Hereditary and Metabolic Diseases, the Society of Pediatrics. Chinese Medical Association, Editorial Board. Chinese Journal of Pediatrics . Expert Consensus on the Standardized Diagnosis and Management of Type 1 Diabetes Mellitus in Chinese Children (2020). Zhonghua Er Ke Za Zhi (2020) 58:447–54. 10.3760/cma.j.cn112140-20200221-00124 - DOI - PubMed
    1. Tauschmann M, Hermann JM, Freiberg C, Papsch M, Thon A, Heidtmann B, et al. . Reduction in Diabetic Ketoacidosis and Severe Hypoglycemia in Pediatric Type 1 Diabetes During the First Year of Continuous Glucose Monitoring: A Multicenter Analysis of 3,553 Subjects From the DPV Registry. Diabetes Care (2020) 3:e40–2. 10.2337/dc19-1358 - DOI - PubMed
    1. Nathan DM, DCCT/EDIC Research Group . The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: overview. Diabetes Care (2014) 1:9–16. 10.2337/dc13-2112 - DOI - PMC - PubMed

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