, Volume 25, Issue 10, pp 881–897 | Cite as

Continuous Subcutaneous Insulin Infusion versus Multiple Daily Injections of Insulin

Economic Comparison in Adult and Adolescent Type 1 Diabetes Mellitus in Australia
  • Neale Cohen
  • Michael E. MinshallEmail author
  • Lyn Sharon-Nash
  • Katerina Zakrzewska
  • William J. Valentine
  • Andrew J. Palmer
Original Research Article


Background: Recent meta-analyses in the published medical literature have found improved glycaemic control with continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) of insulin for patients with diabetes mellitus. In Australia, CSII is predominantly used in type 1 diabetes mellitus (T1DM) patient populations.

Objective/intervention: To project long-term costs and outcomes of CSII (Novorapid® or Humalog®) compared with MDI (NPH insulin plus Novorapid® or Humalog®) in adult and adolescent T1DM patients in Australia.

Methods: The study was a modelling analysis utilising a lifetime horizon in adult and adolescent specialty care T1DM patient populations from Australia. Published Australian diabetes complication costs (adjusted to Australian dollars [$A], year 2006 values), treatment costs and discount rates of 5.0% per annum were applied to costs and clinical outcomes. A lifetime horizon was taken, considering only direct medical costs and excluding indirect and non-medical costs.

The validated CORE diabetes model employs standard Markov/Monte Carlo simulation techniques. It was used to simulate diabetes progression in Australian adult (mean age 43 years, duration of diabetes 17 years, mean glycosylated haemoglobin [HbA1c] 8.2%) and adolescent (mean age 17 years, duration of diabetes 6 years, mean HbA1c 8.9%) patients with baseline characteristics taken predominantly from Australian National Diabetes Information Audit and Benchmarking (ANDIAB) in Australia.

The main outcome measures were incremental costs and effectiveness of CSII compared with MDI in Australian adult and adolescent patients with T1DM.

Results: Mean direct lifetime costs were $A34 642 higher with CSII treatment than with MDI for adult patients and $A41 779 higher for adolescent patients. Treatment with CSII was associated with an improvement in life expectancy of 0.393 years for adults compared with MDI and 0.537 years for adolescents. The corresponding gains in QALYs were 0.467 QALYs and 0.560 QALYs for adults and adolescents, respectively. This produced incremental cost effectiveness ratios (ICERs) of $A88 220 and $A77 851 per life-year gained for CSII compared with MDI for adult and adolescent T1DM patients, respectively, in Australia. These data also produced corresponding ICERs of $A74 147 per QALY and $A74 661/QALY for adult and adolescent T1DM patients, respectively. Sensitivity analyses suggested that our base-case assumptions were mostly robust with improvements in ICERs for reduction in hypoglycaemic events with CSII treatment and worse ICERs for lower HbA1c changes associated with CSII treatment compared with MDI.

Conclusions: Our analysis suggests that CSII is associated with ICERs in the range of $A53 022–259 646 per QALY gained, with most ICERs representing good value for money in Australia under the majority of scenarios explored.


Insulin Glargine Insulin Detemir Continuous Subcutaneous Insulin Infusion Multiple Daily Injection Insulin Pump Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was supported by an unrestricted grant from Medtronic Australasia to IMS Health. The authors would like to thank Medtronic-Australasia for providing the funding for this project. Medtronic-Australasia did not have a role in directing the outcome of this modelling analysis, but provided information used in the manuscript.

Lyn-Sharon Nash is an employee of Medtronic Australasia and holds stock options. At the time of the analysis, Katrina Zakrzewska was an employee of Medtronic EU, Tolochenaz and Andrew Palmer was an employee of IMS Health. Neale Cohen has received consultancy fees from Medtronic Austalasia.

Supplementary material

40273_2012_25100881_MOESM1_ESM.pdf (97 kb)
Supplementary material, approximately 99 KB.


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Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  • Neale Cohen
    • 1
  • Michael E. Minshall
    • 2
    Email author
  • Lyn Sharon-Nash
    • 3
  • Katerina Zakrzewska
    • 4
  • William J. Valentine
    • 5
  • Andrew J. Palmer
    • 5
  1. 1.International Diabetes InstituteCaulfieldAustralia
  2. 2.Health Economics and Outcomes Research, IMS-HealthNoblesvilleUSA
  3. 3.Medtronic AustralasiaGladesvilleAustralia
  4. 4.Novartis Pharmaceuticals UK Ltd.West SussexUK
  5. 5.Health Economics and Outcomes Research, IMS-HealthAllschwilSwitzerland

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