NZSSD Position Statement on Insulin Pump Therapy

NZSSD welcomes the "Systematic Review Update and Economic Evaluation for the New Zealand Setting on Subcutaneous Insulin Pump Therapy." The major conclusions of this study are that the improvement in glycaemic control is of "small magnitude and of borderline statistical significance". This is regardless of the patient population studied (adults, children, adolescents, Type 1 or Type 2 diabetes). The report estimates that the cost/QALY is likely to exceed $100,000.

In response to this systematic review, NZSSD believes that certain patient populations are more likely to derive clinical benefit from insulin pump therapy than others, for example, those with Type 1 diabetes who experience recurrent severe hypoglycaemia despite multiple daily injections (MDI). Studies of insulin pump therapy v MDI have not addressed this particular patient population specifically.

The National Institute for Health and Clinical Excellence (NICE) [1] in the UK have recently re-appraised the use of insulin pump therapy and have concluded that they constitute an appropriate treatment option for adults and children 12 years and older with type 1 diabetes mellitus provided that:

Insulin pump therapy is currently funded on a population based formula, essentially resulting in each district health board (DHB) receiving a fixed amount of annual funding for insulin pump therapy. Given this scenario an individual DHB can only fund a fixed number of people on insulin pumps (assuming that funding pays for the pump and consumables), since after several years all of the funding is required for funding the consumables of those established on pump therapy.

This creates a "first come first served" situation which is not equitable. Individual DHB's have attempted to address this issue in a variety of ways (e.g. some choosing to only fund pumps and not consumables, others acquiring pumps through other funding streams). This has resulted in significant variability of insulin pump services in different regions throughout New Zealand.

The NZSSD Executive believes that Insulin Pump Therapy should be available:

NZSSD, June 2008

 

  1. National Institute For Health And Clinical Excellence, Final appraisal determination. Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus (review of technology appraisal guidance 57):
    http://www.nice.org.uk/nicemedia/pdf/FinalAppraisalDeterminationIP.pdfat 31 May 2008
  2. Severe defined as disabling hypoglycaemia requiring administration of glucagon or intervention by medical personnel.

Original report

Campbell S, Suebwongpat A, Standfield L, Weston A. Systematic review update and economic evaluation for the New Zealand setting: Subcutaneous insulin pump therapy. HSAC Report 2008; 1(3). Available online at:
http://www.hsci.canterbury.ac.nz/documents/SubcutaneousInsulinPump.pdf