Health economic comparison between continuous subcutaneous insulin infusion and multiple daily injections of insulin for the treatment of adult type 1 diabetes in Canada

Clin Ther. 2009 Mar;31(3):657-67. doi: 10.1016/j.clinthera.2009.03.013.


Background: Patients with type 1 diabetes mellitus (DM) may be treated with insulin via multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII).

Objective: The purpose of this study was to evaluate the projected long-term cost-effectiveness of CSII compared with MDI by modeling a simulated sample of adult patients with type 1 DM in Canada.

Methods: A health economic model was used to determine the incremental cost-effectiveness ratio (ICER) of CSII compared with MDI from the perspective of a Canadian provincial government. The primary input variable was change in glycosylated hemoglobin (HbA(1c)). A series of Markov constructs also simulated the progression of disease-related complications. Annual acquisition costs for CSII and MDI were year-2006 Can $6347.18 and Can $4649.69, respectively. A 60-year time horizon and a discount rate of 5.0% per annum on costs and clinical outcomes were used.

Results: Mean direct lifetime costs were Can $15,591 higher with CSII treatment than MDI. Treatment with CSII was associated with an improvement in discounted life expectancy of 0.655 quality-adjusted life-years (QALYs) over a 60-year time horizon, compared with MDI (mean [SD], 10.029 [0.133] vs 9.374 [0.076] QALYs). ICERs were Can $27,264 per life-year gained and Can $23,797 per QALY for CSII compared with MDI. The results were most sensitive to HbA(1c) assumptions.

Conclusion: Based on this analysis, CSII may be a cost-effective treatment option when compared with MDI in adult patients with type 1 DM in Canada.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomarkers / blood
  • Canada
  • Computer Simulation
  • Cost-Benefit Analysis
  • Diabetes Complications / economics
  • Diabetes Complications / therapy
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 1 / economics*
  • Drug Administration Schedule
  • Drug Costs
  • Female
  • Financing, Government*
  • Glycated Hemoglobin A / metabolism
  • Health Care Costs*
  • Humans
  • Hypoglycemic Agents / administration & dosage*
  • Hypoglycemic Agents / economics*
  • Injections, Subcutaneous
  • Insulin / administration & dosage*
  • Insulin / economics*
  • Insulin Infusion Systems / economics*
  • Life Expectancy
  • Male
  • Markov Chains
  • Models, Economic
  • Quality-Adjusted Life Years
  • Time Factors
  • Treatment Outcome
  • Young Adult


  • Biomarkers
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin
  • hemoglobin A1c protein, human