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Cost-effectiveness of continuous subcutaneous insulin infusion (CSII) in children: illusion or delusion?

Roos Nuboer1, G Jan Bruining

  • 1Department of Paediatrics, Meander Medical Center, Amersfoort, the Netherlands. r.nuboer@meandermc.nl

Pediatric Diabetes
|June 16, 2006
PubMed

Insights

Continuous subcutaneous insulin infusion (CSII) may offer benefits over multiple daily injections (MDI) for children with diabetes, but cost-effectiveness requires better well-being assessment. More research is needed to compare these diabetes management methods.

Area of Science:

  • Pediatric Endocrinology
  • Health Economics
  • Diabetes Management

Background:

  • Continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) are primary methods for pediatric diabetes management.
  • Assessing the cost-effectiveness of CSII versus MDI in children requires a comprehensive understanding of clinical efficacy and patient-reported outcomes.

Purpose of the Study:

  • To review the cost-effectiveness of CSII compared to MDI in children with diabetes.
  • To evaluate clinical benefits, including hemoglobin A1c (HbA1c) levels, and perceived benefits by patients and parents.

Main Methods:

  • Review of existing literature on cost comparisons and clinical efficacy of CSII versus MDI in pediatric populations.
  • Analysis of direct extra costs associated with CSII, including pump supplies and maintenance.
  • Comparison of outcomes from randomized and non-randomized studies.

Main Results:

  • Direct extra costs for CSII can be approximately double those of MDI (5000-6000 EUR vs. 3000 EUR per patient year).
  • Randomized trials show limited significant clinical differences between CSII and MDI in children, while non-randomized studies suggest CSII may be favored.
  • Quality of life parameters are inadequately assessed in current comparisons.

Conclusions:

  • There is a significant need for improved parameters to assess the well-being of children with diabetes using CSII or MDI.
  • Accurate cost-effectiveness analysis of CSII versus MDI in pediatric populations is currently limited by a lack of comprehensive outcome measures.

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