What do insulin pumps cost

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. This study evaluates patterns of healthcare utilization, costs, and blood glucose control for patients with diabetes who initiate CSII. 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.

Conclusions: For adults with insulin-requiring diabetes, transitioning from MDII to CSII was associated with modest improvements in A1C but more hypoglycemia encounters and increased healthcare expenditures, without significant improvement in other potentially offsetting areas of healthcare consumption.

Takeaway Points. Diabetes affects 29 million Americans, imposing a substantial health and economic burdens on the US population. These activities increase healthcare expenditures and are perceived by many patients to reduce their quality of life QOL.

Prior research has suggested some potential advantages of CSII over MDII therapy, such as reduced pain, less stigma, lower frequency and severity of hypoglycemia, and overcoming some barriers to adherence. Health payers generally offer insurance coverage for CSII to patients who meet specific clinical criteria and demonstrate good self-management practices and participation with healthcare visits.

Medicare provides coverage for CSII in patients who have evidence of either: a prior use of CSII with adherence to glucose self-testing prior to Medicare enrollment, or b persistent hyperglycemia, recurring hypoglycemia, or other forms of poor blood glucose control despite completion of a comprehensive diabetes education program and adherence to glucose self-monitoring and MDII for at least 6 months.

A related important question is whether those outcomes might vary among different subgroups of patients. We used a pre-post with propensity-matched comparison group quasi-experimental study design with difference-in-differences estimation to evaluate patterns of healthcare costs, utilization, and blood glucose control associated with the initiation of CSII by adults with insulin-requiring diabetes who received health insurance coverage from a single, large, nationwide commercial health insurer.

The study design is depicted in Figure 1 and described further below. The evaluation sample included patients with insulin-requiring diabetes who were aged 18 to 64 years. XX and at least 1 dispensing event for MDII, but no previous use of an oral hypoglycemic class medication. This exclusion made it more likely, but not certain, that individuals included in the study had T1D.

Additional CSII-related utilization and supplies were identified using specific procedural and encounter codes see eAppendix Table 1 for details [ eAppendix available at ajmc. The date of the first occurrence of one of these codes within days before the pump device dispensing date was defined as the index date for our pre-post analysis Figure 1.

In follow-up analyses, CSII initiators were considered to have stopped CSII if they had days of enrollment without any claims for CSII-related supplies or services and had at least 2 basal insulin refills during that same period.

To identify a comparison group with similar baseline characteristics, we used a nearest-neighbor propensity-matching approach. To enable direct comparisons between groups, matched control clients were assigned the same index date as the CSII initiator to whom they were paired. To construct baseline variables for the match, individuals in both groups were required to have continuous health plan enrollment for at least 3 months before and 3 months after the index date.

Study outcomes included direct medical costs, categorized as inpatient, outpatient, pharmacy, and total healthcare costs; emergency department ED visits; encounters for hypoglycemic events; and, when available, A1C values. Total healthcare costs, including both health plan and patient cost share components, were assessed equally across all patient groups by applying a standardized price for each claim.

To minimize the effect of extreme outliers on mean cost estimates, we replaced costs above the 95th percentile with the 95th percentile value. Data sources included national member enrollment files, medical inpatient and ambulatory claims, and pharmacy claims made available by a large US-based commercial health insurer. Although the completion of all laboratory tests including A1C tests could be determined for all patients in both groups ie, based on laboratory claims , a subset of national commercial laboratory vendors also included the laboratory result with each claim submitted to the payer.

The Northwestern University Institutional Review Board reviewed the parent study and determined that this work involved the use of coded, nonidentifiable data and was not classifiable as human subjects research. Univariate and bivariate descriptive statistics for baseline characteristics were calculated for both CSII initiators and the matched MDII comparison group.

Means of continuous outcomes were plotted for each day period before and after the index date to observe comparability of time trends between groups. To minimize the potential for bias introduced by the nonrandomized study design, we used a pre-post with propensity-matched comparison group design.

We estimated mean between-group differences in quarterly outcomes over different time horizons year 1, year 2, year 3 using enrollee-level difference-in-differences random effects regression models that included a dummy variable for group CSII initiator versus MDII , calendar year indicators ie, calendar year of the index date , exposure year ie, year 1, 2, or 3 relative to the index date , and group-by-exposure-year interaction terms.

For estimating continuous outcomes, we used linear models because they provide estimates in natural units of the outcome variable and have been shown to produce reliable and unbiased estimates of mean cost differences and CIs when sample sizes are large.

Analyses were conducted on the overall sample as well as across prespecified patient subgroups, including different pump-qualifying diagnoses—hypoglycemia encounters or evidence of poor glycemic control within days of the index date—and whether or not the CSII initiator also used real-time continuous glucose monitoring rt-CGM see eAppendix Table 1. Because our analysis assumed a health payer perspective, each patient who was no longer enrolled with the health plan was censored from future measurement periods, rather than imputing missing data or assuming them to have zero costs.

To avoid potential bias from differential dropout rates across the 2 groups, we censored both the CSII initiator and matched control patient at any point when either one was no longer enrolled in the health plan. This reduced sample sizes but ensured comparability throughout the evaluation period. The baseline characteristics of CSII initiators and matched controls are presented in Table 1. There were no statistically significant differences in any major characteristics between the 2 comparison groups, with good balance on sex, age, comorbidity index score, frequencies of encounters for hypoglycemia or hyperglycemia, and visits to endocrinologists.

Now I would not want to go back. Before the pump, diabetes controlled my life. With the pump, I feel like I am now in control of my diabetes—and my life. I was on an insulin pump for more than 2 years, and then I quit. For me, the hassle of constantly taking my blood sugar and figuring out how to program my doses wasn't worth it. Plus, I got a lot of infections at the catheter site. I went back to injections and feel happier with my life now.

I got my pump as a teenager, and I love it. I'm a police officer now, and having a pump makes it much easier to do my job. I have several reasons for not wanting an insulin pump. I'm a pretty private person and I wouldn't want people to notice that I'm wearing a pump. Also, I play football and basketball almost year-round, and it's a big part of my life. I know you can safely disconnect the pump for an hour or so, but my games last longer than that. I just don't like the idea of a pump.

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

I feel ready to take on the responsibilities involved in using an insulin pump. I want a more flexible lifestyle than my current insulin shot schedule allows. My schedule is the same every day, so it's not hard to schedule my shots. Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now. How sure do you feel right now about your decision? Here's a record of your answers.

You can use it to talk with your doctor or loved ones about your decision. Using and caring for an insulin pump seems too complicated for me. Are you clear about which benefits and side effects matter most to you? Do you have enough support and advice from others to make a choice?

Author: Healthwise Staff. Medical Review: E. This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

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Selecting these links will take you away from Cigna. Cigna may not control the content or links of non-Cigna websites. Overview Medicare Coverage Options. Broker Resources. Individuals and Families. Health and Wellness. Wellness Library. Get the facts. Your options Get an insulin pump.

Keep doing insulin injections. 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. When you use a pump, you will need to check your blood sugar many times a day or use a continuous glucose monitor.

You will need to carefully count 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. What is an insulin pump?

What are the benefits of using an insulin pump? With a pump, you can plan your insulin around your life instead of planning your life around your insulin shots. Your basal rate is set and runs automatically.

If you decide to stay out late, skip a meal, or work at a job with changing shifts, you can adjust your insulin at the push of a button. A pump can deliver an exact amount of insulin and in very small amounts.

Instead of giving yourself shots several times a day, you only need to insert a catheter needle once every 2 or 3 days. With a pump, you don't have to stop what you're doing and pull out a syringe or an insulin pen to give yourself insulin. You just push a button to give yourself the right dose. A pump may help you keep your blood sugar in your target range.

People who use a pump have fewer big swings in their blood sugar levels. Pumps work well for people who can't find an insulin dose that keeps blood sugar under control without also causing low blood sugar.

What are the drawbacks of using an insulin pump? You may have to stay in the hospital, or spend a whole day at a clinic, while you learn how to use your pump. Setting your basal rates for the first time may take a few days. You may have to skip a few meals and check your sugar levels extra often while you get used to the pump.

People who keep their sugar levels in a tight range may be less able to sense when their blood sugar is low. You should also advise patients of the appropriate infusion set and reservoir for the pump, so that they can order consumables through your state Diabetes Australia office.

This provides support for childcare payments for parents with children under The application form can be found here:. Terms and Conditions apply. If the patient is an Australian Resident who has insulin dependent Type 2 diabetes and private health insurance, the cost of the pumps is generally covered by their insurance provider depending on their level of hospital cover. They can apply for this grant to access pump consumables at a reduced cost.

Pump consumables are an essential part of insulin pump therapy. Successful applicants will receive a Medtronic insulin pump. Pump model and colour are subject to availability. Skip to main content. Who is eligible for NDSS subsidies?