Comparative Effectiveness And Costs Of Insulin Pump Therapy For Diabetes
Ronald T. Ackermann, MD, MPH; Amisha Wallia, MD, MS; Raymond Kang, MA; Andrew Cooper, MPH; Theodore A. Prospect, FSA, MAAA; Lewis G. Sandy, MD, MBA; and Deneen Vojta, MD Evaluation of healthcare utilization and costs over 3 years for adults with insulin-requiring diabetes who transition from multiple daily insulin injections to insulin infusion pumps. ABSTRACT Objectives: Continuous subcutaneous insulin infusion (CSII), or “insulin pump” therapy, is an alternative to multiple daily insulin injections (MDII) for management of diabetes. This study evaluates patterns of healthcare utilization, costs, and blood glucose control for patients with diabetes who initiate CSII. Study Design: Pre-post with propensity-matched comparison design involving commercially insured US adults (aged 18-64 years) with insulin-requiring diabetes who transitioned from MDII to CSII between July 1, 2009, and June 30, 2012 (“CSII initiators”; n = 2539), or who continued using MDI (n = 2539). Methods: Medical claims and laboratory results files obtained from a large US-wide health payer were used to construct direct medical expenditures, hospital use, healthcare encounters for hypoglycemia, and mean concentration of glycated hemoglobin (A1C). We fit difference-in-differences regression models to compare healthcare expenditures for 3 years following the switch to CSII. Stratified analyses were performed for prespecified patient subgroups. Results: Over 3 years, mean per-person total healthcare expenditures were $1714 (95% confidence interval [CI], $1184-$2244) higher per quarter for CSII initiators compared with matched MDII patients (total mean 3-year difference of $20,565). Compared with matched controls, mean A1C concentrations became lower for CSII initiators by 0.46% in year 2 (P = .000 Continue reading >>
- Comparative Effectiveness and Costs of Insulin Pump Therapy for Diabetes
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Insulin Pump Therapy for Kids
Diabetes: Should I Get An Insulin Pump?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them. Get the facts Key points to remember An insulin pump can free you from a strict regimen of meals, sleep, and exercise, because you can program it to match your changing schedule. After you learn how to work with a pump, it can make living with diabetes easier. But it takes some time and effort to learn how to use the pump to keep it working properly and to control your diabetes. Using a pump includes checking your blood sugar many times a day and carefully counting the grams of carbohydrate that you eat. Using an insulin pump can keep your blood sugar at a more constant level so that you don't have as many big swings in your levels. People who use pumps have fewer problems with very low blood sugar. Many insurance companies cover the cost of insulin pumps, but they have strict guidelines that you will have to follow before they will pay. Continue reading >>
- How did I get fat? How did I get diabetes? How did I get so unhealthy?
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Should I Get a Flu Shot if I Have Diabetes?
How Much Do Diabetes Supplies/medications Cost In The U.s.?
While everyone’s diabetes treatment plan, medications, and technology may be different, there is one thing we can all agree on: diabetes is expensive. In two previous posts at The Perfect D, I gave some sense of what the bare minimum of care for a U.S. adult with Type 1 diabetes would be and also financial resources and programs to help with the financial burden of living with diabetes. However, this post is about how much it could cost an adult with Type 1 diabetes if they used the technology and medications that are currently out on the market (and thought of as “the latest and greatest”) and paid out of pocket with no insurance. Research on this topic has shown me that: 1) prices can fluctuate wildly, so it pays to shop around and 2) there is a very big gap (financially, medically, and technologically) between the bare minimum and “surviving” and actually utilizing the tools and latest technology that is out there. So, the hypothetical person for this exercise is a Type 1 adult in the United States who weighs 60kg, just like the other calculation post I did. Ground Rules These prices are accurate on the websites I have referenced for December 1, 2014. They may change, they may add shipping, they may not offer the services, technology, or drugs on their website after this is posted. These prices are not a guarantee. They are to be used as a reference. The listing of prices/websites on this post does not mean that I endorse the company or product or service. I have not listed all the products available on the market for people with Type 1 diabetes. I have listed major ones to give you an idea of major manufacturers’ costs for the products that are available for general public viewing. I did not call any companies and ask for pricing. Why? Because I believe Continue reading >>
Insulin Prices Have Skyrocketed, Putting Drug Makers On The Defensive
Here’s a sticking point for diabetics: the cost of insulin more than tripled — from $231 to $736 a year per patient — between 2002 and 2013, according to a new analysis. The increase reflected rising prices for a milliliter of insulin, which climbed 197 percent from $4.34 per to $12.92 during the same period. Meanwhile, the amount of money spent by each patient on other diabetes medications fell 16 percent, to $502 from $600, according to a research letter published Tuesday in the Journal of the American Medical Association. “Insulin is a life-saving medication,” said Dr. William Herman, a coauthor of the analysis and a professor of medicine and epidemiology at the University of Michigan School of Public Health. “There are people with type 1 diabetes who will die without insulin. And while there have been incremental benefits in insulin products, prices have been rising. So there are people who can’t afford them. It’s a real problem.” The analysis also found that the cost of various widely used oral diabetes drugs either dropped in price or did not rise nearly as significantly as insulin. Metformin, for instance, which is available as a generic, fell to 31 cents in 2013 from $1.24 per tablet in 2002. And the newer class of diabetes drugs known as DPP-4 inhibitors rose 34 percent since becoming available in 2006. The researchers analyzed data from nearly 28,000 diabetes patients found in the Medical Expenditure Panel, a database on health care costs maintained by the US Department of Health and Human Services. About 1 in 4 people used insulin and two-thirds took a pill. Toward the end of the study period, a small percentage began taking new injectable medicines that are designed to complement pills. There have been previous efforts to track insulin pric Continue reading >>
Cost Of Insulin Pumps
Tweet Insulin pumps are costly items but may be possible to fund for some households. Those considering buying an insulin pump should consider not only the cost of the pump, including the monthly consumables, accessories and insurance but, importantly, how you will receive the required insulin pump centred care. Most people in the UK who have a pump have it funded by the NHS. If you have an insulin pump on the NHS, you may need to cover some of the costs which may include insurance, accessories and, in the case of some pumps, glucose sensors as well. Insulin pump costs The cost of insulin pumps is often between £2000 and £3000. NICE guidance in 2008 records the following costs of insulin pumps: Johnson & Johnson - Animas 2020 - £2600 Medtronic - Paradigm real-Time MMT-522 - £2750 Medtronic - Paradigm real-Time MMT-722 - £2750 Roche - Accu-Chek Spirit - £2375 Deltec Cozmo - £2750 Newer insulin pumps are now available but prices of most pumps have stayed within similar price boundaries. Where can I buy an insulin pump? In the UK, you will need to choose which insulin pump is right for you and then and contact the insulin pump manufacturer. If you do not meet the clinical criteria for having an insulin pump via the NHS and you wish to purchase an insulin pump, you will need to check whether your diabetes clinic is able to and happy to provide all the care you may need. Please note that you should not expect your NHS clinic to necessarily have the resources to cover the care for a patient with a pump bought privately, in which case you will need to arrange diabetes care with a private diabetologist that is qualified to care for people with insulin pumps. It’s important to arrange how you will receive care before you go ahead and purchase an insulin pump. If you are Continue reading >>
Insulin Prices Skyrocketing
America’s getting plenty angry about the rising cost of insulin—and no wonder. Between 2002 and 2013, the average price for this life-saving, injectable drug used by nearly 10 million Americans with diabetes has tripled, according to the American Diabetes Association (ADA). “No one who relies on insulin should have to wonder if they’ll be able to afford it,” the ADA asserts in an online petition for its Stand Up for Affordable Insulin campaign.1 The ADA’s action doesn’t stand alone. In November, Vermont senator and former contender for the Democratic presidential nomination Bernie Sanders fired off a letter calling on the U.S. Justice Department and the Federal Trade Commission asking for an investigation of pharmaceutical makers Eli Lilly, Novo Nordisk and Sanofi for possibly colluding on insulin price increases.2 “Not only have these pharmaceutical companies raised insulin prices significantly—sometimes by double digits overnight—in many instances the prices have apparently increased in tandem,” noted the letter, co-signed by Rep. Elijah Cummings (D-MD). “We have…heard from our constituents that the life-saving insulin they need is increasingly unaffordable,” And in early January 2017, the New York law firm Bernstein Litowitz Berger & Grossmann sued Novo Nordisk on behalf of the Lehigh County (PA) Employees' Retirement System alleging the company “reported materially false and misleading earnings and forecasts” that were “inflated” by price fixing. That’s not all. In a rapidly-changing insulin market, the recent introduction in the U.S. of the generic “biosimilar insulin” called Basaglar, which won FDA approval in December 2015, has put a lower-priced type on the market. This development reportedly prompted two major manufactu Continue reading >>
Touchscreen Meets Insulin Pump In Tandem’s New T:slim
“Design is a funny word. Some people think design means how it looks. But of course, if you dig deeper, it's really how it works … To design something really well, you have to get it. You have to really grok what it’s all about. It takes a passionate commitment to really thoroughly understand something, chew it up, not just quickly swallow it. Most people don’t take the time to do that.” Those were the words of the late Steve Jobs in an interview with Wired in February 1996. More than a decade later, Tandem Diabetes Care took this idea to heart with its new t:slim touchscreen insulin pump, which it designed after conducting a remarkable 4,000 in-depth interviews with patients, healthcare providers, and caregivers. Tandem really wanted to get inside the minds of people who take insulin – pumpers and non-pumpers alike. The new pump was approved by the FDA in November 2011 (see new now next in diaTribe #38) and launched just last month. I was able to get trained on the t:slim at Tandem’s San Diego headquarters soon after it launched, and what follows is my experience wearing the device over the past week. So far, three themes have emerged: some clear differences from other pumps, a focus on simplicity and convenience, and an attention to safety. Part One: Differences from Other Pumps Adam’s Favorites iPhone-like touchscreen Rechargeable battery Highly customizable “personal profiles” for insulin delivery From the minute I opened the shipping box, it was clear that the t:slim pump was somewhat different from other pumps I’ve used – included with the pump were a USB charging cable and adapters for both the wall and car. Even the included user manual comes on a credit-card-like thumb drive. But the most obvious difference between the t:slim and other p Continue reading >>
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Insulin Pump Therapy for Kids
- Comparative Effectiveness and Costs of Insulin Pump Therapy for Diabetes
Insulin Pump Therapy
Insulin pump therapy can give you the better control you want for your lifestyle.1, 2 Technology for Joy & Jake What Is Insulin Pump Therapy? An insulin pump is a small device about the size of a small cell phone that is worn externally and can be discreetly clipped to your belt, slipped into a pocket, or hidden under your clothes. It delivers precise doses of rapid-acting insulin to closely match your body’s needs: Basal Rate: Small amounts of insulin delivered continuously (24/7) for normal functions of the body (not including food). The programmed rate is determined by your healthcare professional. Bolus Dose: Additional insulin you can deliver “on demand” to match the food you are going to eat or to correct a high blood sugar. Insulin pumps have bolus calculators that help you calculate your bolus amount based on settings that are determined by your healthcare professional. Buttons to program your insulin LCD screen to show what you are programming Battery compartment to hold 1 AAA alkaline battery Reservoir compartment that holds insulin A plastic cartridge that holds the insulin that is locked into the insulin pump. It comes with a transfer guard (blue piece at the top that is removed before inserting the reservoir into the pump) that assists with pulling the insulin from a vial into the reservoir. A reservoir can hold up to 300 units of insulin and is changed every two to three days. An infusion set includes a thin tube that goes from the reservoir to the infusion site on your body. The cannula is inserted with a small needle that is removed after it is in place. It goes into sites (areas) on your body similar to where you give insulin injections. The infusion set is changed every two to three days. An infusion set is placed into the insertion device and wi Continue reading >>
- Insulin Pump Therapy for Kids
- Comparative Effectiveness and Costs of Insulin Pump Therapy for Diabetes
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
The Cost Of Insulin Pump Therapy
With eligible hospital insurance you could get coverage for an insulin pump The cost of If you’re living in Australia - the cost of an insulin pump is generally fully covered by your insurance provider depending on your level of hospital cover (assuming the appropriate waiting period has been served). In choosing the health fund that’s best for you, it doesn’t necessarily have to be the most expensive level of cover. If in doubt, check with your private health insurer for what is covered. For the price of a coffee per day, you could get coverage for an insulin pump1 Are you in the interim waiting period for private health cover? NOW YOU MAY BE ELIGIBLE FOR A LOAN PUMP FOR PEOPLE UNDER 18 YEARS OF AGE YOU MAY BE ELIGIBLE FOR A T2 GRANT, OFFERING UP TO 90% OFF RRP5 FOR INSULIN PUMP CONSUMABLES. More Details More Details More Details Continue reading >>
Getting An Insulin Pump
Tweet There is a high level of demand for insulin pumps but currently the UK lags behind other European countries in its provision of insulin pumps. Insulin pumps allow greater opportunity to take control of diabetes but, because they are a more expensive option than injections, eligibility criteria exists to ensure the most suitable candidates have access to insulin pump therapy. Funding options There are two main options for getting an insulin pump: Self funding –whereby you buy the pump and consumables NHS funded –the pump is paid for by the NHS for those meeting eligibility criteria The most common option for getting an insulin pump in the UK is to have one funded by the NHS. Getting an insulin pump privately If you buy the pump privately, you will need to consider the total cost, including the consumables, and ensure you have a health team with a specialism in insulin pumps. You will need to arrange whether you will be able to receive care on the NHS or privately before going ahead with buying an insulin pump privately. Insulin pumps tend to cost between £2,000 and £3,000 and the consumables for an insulin pump, including infusion sets, reservoirs and batteries, can cost around £1,000 to £2,000 a year. The NHS does not operate a scheme in which it funds pumps which have been bought privately. Getting a pump on the NHS The process of getting an insulin pump can vary across different parts of the UK as budgets, the level of demand for pumps and the number of healthcare professionals with experience of insulin pumps can all play a part. The advantage of applying for an insulin pump through the NHS is that you have the chance of getting the pump for free. This for most people outweighs the disadvantages of not knowing whether or when they may qualify for a pump Continue reading >>
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Why treating diabetes keeps getting more expensive
- How statins can cause diabetes: Pills raise the risk of getting disease by 46 per cent
Soaring Insulin Prices Prompt Insurance Shift
Since 2002, the cost of insulin has increased by almost 200 percent, according to a new study.Video provided by Newsy Newslook Corrections and clarifications:This story has been updated to reflect fact that Basaglar can’t be used in an insulin pump. Many parents of diabetic children and adults suffering with type 1 or type 2 diabetes are bracing for changes in insurance coverage of their insulin next year, as prices of the vital medication continue to soar. Higher insurance deductibles and changes in the prescription brands covered by some insurers are raising concerns among some people with diabetes. CVS Caremark, a pharmacy benefit manager (PBM), will no longer cover the insulin brand Lantus in favor of a new biosimilar version, Basaglar. Biosimilars are considered the generic versions of "biologic" drugs that are based on natural sources. The company also announced a program last week to further keep diabetes costs down, following a similar move in August by competitor Express Scripts. Diabetes is an epidemic in the United States, affecting nearly 10% of the population or about 29 million people, according to the Centers for Disease Control and Prevention. Of those, more than 8 million people are undiagnosed. Type 1 diabetes — often still called juvenile diabetes — can occur when people are children or adults. Type 2 diabetes is becoming more common with the increase in obesity and sedentary behavior. Prices for Humalog and many insulin brands have increased from about $300 to $500 between January 2013 to October 2016, according to drug discount search company GoodRx. Lantus increased about 60% — from $240 to $380 — in the same time period, GoodRx says. (Photo: T1D Exchange) "It’s definitely unfortunate prices are going up so much and impacting the people Continue reading >>
Diabetics Can Spend $1,000 A Month Taking Care Of Themselves — And It's Not Just Because Of Insulin
A paramedic checking the blood sugar levels of a diabetes patient. Beawiharta Beawiharta/Reuters Diabetes, in particular type 1 diabetes, can be an expensive chronic disease to manage. That's being felt as the cost of insulin increases, while at the same time high health insurance deductibles leave families on the hook to cover more of the cost than ever before. It means, in some cases, all the expenses can climb past $1,000 a month. There are two types of diabetes of which nearly 29.1 million Americans have one or the other. Type 1 is an autoimmune disease, in which the body mistakenly kills so-called beta cells that are supposed to make the body's insulin, a hormone that helps people absorb and process the sugar in food. This kind of diabetes can affect any age group, though it's most often diagnosed in children, teens, and young adults. The roughly 1.25 million people in the US who have Type 1 diabetes need to inject insulin to live. Type 2 diabetes, the more common form, is something that develops either based on genetic or lifestyle choices, and doesn't always require that you need to take insulin. But insulin isn't the only thing type 1 diabetics have to keep track of. There are a lot of supplies that come with the diagnosis: there are test strips, which help monitor blood sugar levels there are lancets that are used to draw the blood, not to mention alcohol swabs to clean the area where injections happen. There are also the needles/syringes you need to inject the insulin. There's also a device called glucagon, an emergency drug for diabetics that is kind of like the EpiPen. If a diabetic' blood sugar gets too low and he or she passes out, someone can administer the glucagon to get their blood sugar levels back up to non-emergency levels. Some also choose to use a Continue reading >>
Financial Concerns About Insulin Pumps
Many concerns arise when patients consider the costs of insulin pump therapy. The following are a few of the most frequently asked questions: What is the cost of a pump? About $6,000 is the average price. How much of the cost will my insurance cover? Most insurance plans provide coverage for insulin pump therapy and diabetes testing supplies under a Durable Medical Equipment (DME) clause. Pump manufacturers’ insurance departments have the expertise to negotiate approval for payment with your insurance provider. If you have a co-payment, the manufacturer will set up a payment plan, if necessary. Medicare and Medicaid plans also provide coverage, but you should check with the plan administrator in your state. What is the cost of supplies? Monthly costs for intensive insulin pump management supplies can range from $250 to $500, depending on your insurance plan and on the frequency of site changes. Here are potential costs for 10 set changes per month (every three days): Needle set Approximately $6.90 per set $69 90-degree insertion cannula Depending on the brand, $10.83 per set or $13.50 per set $108.30 $135 30-degree insertion cannula $11 per set $110 Pump syringes $10 per month $37-$46 Sterile dressings and skin prep $10 per month Example: box of 50 IV prep wipes Some vendor cash prices can be 30%-50% less than billed list price. Ask about payment options and discounts. $32 (billed) $16 (cash) Insulin Depends on coverage/co-pay/amount used. Variable Test strips Minimum of four daily multiplied by cost per strip. Approximately .75 to $1.00 per strip. Usually covered by insurance. $3-$10 per day Prices shown are estimates only. Vendor and manufacturer prices vary and can change at any time. How can we save money on supplies? If you use sites and supplies beyond the recom Continue reading >>
Insulin Pumps
Not Just for Type 1 An estimated 350,000 people in the United States use insulin pumps today, and about 30,000 of those are believed to have Type 2 diabetes. Surprised? Type 2 diabetes is a progressive disease that causes many people who have it to eventually need to use insulin to control their blood glucose levels. Although many people still think insulin pumps are only for treatment of Type 1 diabetes, they can also be useful for some people with Type 2 diabetes. According to Charles H. Raine III, MD, a diabetologist in Orangeburg, South Carolina, who himself has Type 2 diabetes and uses an insulin pump, the criteria for a good pump candidate are the same, no matter what type of diabetes a person has. In general, a good pump candidate has uncontrolled blood glucose, but also has a desire to try for better control of his diabetes, is willing to measure and document food intake and blood glucose levels, and is physically, emotionally, and cognitively able to manage a pump (or has a caregiver who is). Another important characteristic is a willingness to keep appointments with members of his diabetes care team. Insulin pumps are cell-phone-size devices used to deliver preprogrammed and user-adjusted doses of insulin. Depending on the brand and model, they hold between 180 and 315 units of insulin. Most people use rapid-acting insulin — options include insulin lispro (brand name Humalog), insulin aspart (NovoLog), and insulin glulisine (Apidra) — in their pumps, with a few using Regular. Instead of using an intermediate- or long-acting insulin as a background — or basal — insulin, a user simulates the pancreas’s steady release of insulin by programming the pump to automatically give small amounts of the rapid-acting or Regular insulin around the clock, based on Continue reading >>
The Cost Of Having A Child With Diabetes
We all know the ultimate cost that living with Diabetes places on the PWD and their families. The mental burden of living with diabetes and caring for someone that lives with Diabetes can become overwhelming as it is. While previously we discussed about the increasing prices of insulin and its rise to an all-time highs, it is only a small piece of the puzzle, a small glimpse of the bigger picture of what it truly costs for someone with diabetes to stay ALIVE each and every month. We are not talking about just managing, or being healthy, but staying ALIVE. Let that word sink in for a moment with you. Yes, there are medications one takes to feel better, ibuprofen for a headache, or Tylenol for aches and pains, however, insulin and other diabetes related supplies are the few things that stand between someone with diabetes and death. Am I being over dramatic? Not really when you think about it, insulin is not a cure; it is not a medication you can miss for a day and still be okay the next day. While you may not necessarily DIE from one missed day of a dose of insulin, I can tell you that you will not feel good at all and may actually end up in the hospital. As you may be aware, I have two children who have type 1 diabetes, so I know a little bit about the costs of living with it, even though I do not live with the disease myself. I wanted to put together something that showed those with and especially those without diabetes how much it truly costs for people with this chronic illness to LIVE. The Burden of Diabetes The one thing that has always bugged me about this disease other than the most common reasons is the financial cost it takes to keep someone with Diabetes alive! Thankfully, we have insurance that covers for the majority of the cost, but I know there are people o Continue reading >>
