[Cost-effectiveness of continuous subcutaneous insulin infusion therapy for type 1 diabetes]. / Omkostningseffektivitet ved behandling af type 1-diabetes med insulinpumpe.

INTRODUCTION: This study's aim was to project the long-term clinical and economic outcomes of continuous subcutaneous insulin infusion (CSII) treatment compared to multiple daily injections (MDI) in type 1 diabetes patients in Denmark. MATERIAL AND METHODS: The CORE diabetes model was used to project life expectancy, quality-adjusted life expectancy, cumulative incidence of diabetes-related complications and costs over patient lifetimes. The simulated cohort was based upon a recent meta-analysis of CSII treatment from over 50 studies. Direct and indirect costs (human capital approach) from a healthcare payer perspective were accounted in year 2005 local currency. Outcomes were discounted according to recommendations and simulations performed over a 60 year time horizon. RESULTS: CSII treatment was associated with improved life expectancy, quality-adjusted life expectancy and reduced incidence of most diabetes-related complications compared to MDI. In the base case analysis, lifetime costs were higher for CSII than for MDI with incremental cost-effectiveness ratios in terms of cost per quality-adjusted life year gained within the range generally considered good value for money. Sensitivity analyses revealed that the findings were most sensitive to variation in assumptions regarding time horizon and hypoglycaemic event rate. CONCLUSION: CSII led to improved long-term clinical outcomes due to improved glycaemic control versus MDI. Evaluation of the economic impact of CSII treatment versus MDI demonstrated that it would be likely to represent good value for money by currently accepted standards.

Beyond conventional stroke guidelines: setting priorities.

BACKGROUND AND PURPOSE: Priorities in the care of stroke patients are often intuitive. An open and translucent priority-setting procedure would benefit patients, professionals, and decision-makers. Prioritization is an innovative part of the new Swedish national stroke guidelines. METHODS: Working groups identified diagnostic procedures, interventions and therapies in stroke care, assessed each one according to severity (needs), effect of action, level of scientific evidence and cost-effectiveness. The items were then ranked into priority groups from 1 (highest) to 10 (lowest). Procedures lacking evidence for routine clinical use were also identified (and entered a do-not-do list), as well as procedures in research and development. Resource allocations resulting from the priority-setting process were identified. RESULTS: Of 102 core procedures identified, 50 were assigned to high-priority groups (1-3), 29 to moderate priority groups (4-7) and 23 to low priority groups (8-10). Almost a quarter were graded 8 to 10, indicating that they may not necessarily be applied if resources are scarce. Twenty-eight procedures were assigned to the do-not-do list and 16 to the research and development list. CONCLUSIONS: In stroke services, it is possible to identify not only diagnostic procedures and interventions with high priority, but also a considerable number of items used today that have low priority or should not be used at all. Strict adherence to the guidelines would result in a substantial reallocation of resources from low-priority to high-priority areas.