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Estimated Cost-effectiveness of Subcutaneous Insulin Aspart in the Management of Mild Diabetic Ketoacidosis Among Children
IMPORTANCE: Intravenous (IV) insulin infusion is the standard of care for treating diabetic ketoacidosis (DKA) worldwide. Subcutaneous (SC) insulin aspart could decrease the use of health care resources. OBJECTIVE: To compare the cost-effectiveness of mild uncomplicated DKA management with SC insuli...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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American Medical Association
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9449786/ https://www.ncbi.nlm.nih.gov/pubmed/36066894 http://dx.doi.org/10.1001/jamanetworkopen.2022.30043 |
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author | Bali, Ibrahim Abdulaziz Al-Jelaify, Muneera Rashid AlRuthia, Yazed Mulla, Jaazeel Zohair Amlih, Dana Fawzi Bin Omair, Alanoud Ibrahim Al Khalifah, Reem Abdullah |
author_facet | Bali, Ibrahim Abdulaziz Al-Jelaify, Muneera Rashid AlRuthia, Yazed Mulla, Jaazeel Zohair Amlih, Dana Fawzi Bin Omair, Alanoud Ibrahim Al Khalifah, Reem Abdullah |
author_sort | Bali, Ibrahim Abdulaziz |
collection | PubMed |
description | IMPORTANCE: Intravenous (IV) insulin infusion is the standard of care for treating diabetic ketoacidosis (DKA) worldwide. Subcutaneous (SC) insulin aspart could decrease the use of health care resources. OBJECTIVE: To compare the cost-effectiveness of mild uncomplicated DKA management with SC insulin aspart vs IV insulin infusion among pediatric patients from the perspective of a public health care payer using clinical data. DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation included children aged 2 to 14 years presenting to the emergency department of a single academic medical center with mild DKA between January 1, 2015, and March 15, 2020. The medical records for DKA treatment course and its associated hospitalization costs were reviewed. Data were analyzed from January 1, 2015, to March 15, 2020. EXPOSURES: Subcutaneous insulin aspart vs IV regular insulin infusion. MAIN OUTCOMES AND MEASURES: The incremental cost-effectiveness ratio (US dollars per hour), duration of DKA treatment, and length of hospital stay. RESULTS: A total of 129 children with mild DKA episodes (mean [SD] age, 9.9 [3.1] years; 72 girls [55.8%]) were enrolled in the study. Seventy children received SC insulin aspart and 59 received IV regular insulin. Overall, the length of hospital stay in the SC insulin group was reduced (mean, 16.9 [95% CI, −31.0 to −2.9] hours) compared with the IV insulin group (P = .005). The mean (SD) cost of hospitalization in the SC insulin group (US $1071.99 [US $523.89]) was less than that in the IV insulin group (US $1648.90 [US $788.03]; P = .001). The incremental cost-effectiveness ratio was −34.08 (95% CI, −25.97 to −129.82) USD/h. The use of SC insulin aspart was associated with a lower likelihood of prolonged hospital stay (β = −17.22 [95% CI, −32.41 to −2.04]; P = .03) than IV regular insulin when controlling for age and sex. CONCLUSION AND RELEVANCE: Findings of this economic evaluation suggest that SC insulin aspart is dominant vs IV regular insulin in the management of mild uncomplicated DKA in children. |
format | Online Article Text |
id | pubmed-9449786 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-94497862022-09-24 Estimated Cost-effectiveness of Subcutaneous Insulin Aspart in the Management of Mild Diabetic Ketoacidosis Among Children Bali, Ibrahim Abdulaziz Al-Jelaify, Muneera Rashid AlRuthia, Yazed Mulla, Jaazeel Zohair Amlih, Dana Fawzi Bin Omair, Alanoud Ibrahim Al Khalifah, Reem Abdullah JAMA Netw Open Original Investigation IMPORTANCE: Intravenous (IV) insulin infusion is the standard of care for treating diabetic ketoacidosis (DKA) worldwide. Subcutaneous (SC) insulin aspart could decrease the use of health care resources. OBJECTIVE: To compare the cost-effectiveness of mild uncomplicated DKA management with SC insulin aspart vs IV insulin infusion among pediatric patients from the perspective of a public health care payer using clinical data. DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation included children aged 2 to 14 years presenting to the emergency department of a single academic medical center with mild DKA between January 1, 2015, and March 15, 2020. The medical records for DKA treatment course and its associated hospitalization costs were reviewed. Data were analyzed from January 1, 2015, to March 15, 2020. EXPOSURES: Subcutaneous insulin aspart vs IV regular insulin infusion. MAIN OUTCOMES AND MEASURES: The incremental cost-effectiveness ratio (US dollars per hour), duration of DKA treatment, and length of hospital stay. RESULTS: A total of 129 children with mild DKA episodes (mean [SD] age, 9.9 [3.1] years; 72 girls [55.8%]) were enrolled in the study. Seventy children received SC insulin aspart and 59 received IV regular insulin. Overall, the length of hospital stay in the SC insulin group was reduced (mean, 16.9 [95% CI, −31.0 to −2.9] hours) compared with the IV insulin group (P = .005). The mean (SD) cost of hospitalization in the SC insulin group (US $1071.99 [US $523.89]) was less than that in the IV insulin group (US $1648.90 [US $788.03]; P = .001). The incremental cost-effectiveness ratio was −34.08 (95% CI, −25.97 to −129.82) USD/h. The use of SC insulin aspart was associated with a lower likelihood of prolonged hospital stay (β = −17.22 [95% CI, −32.41 to −2.04]; P = .03) than IV regular insulin when controlling for age and sex. CONCLUSION AND RELEVANCE: Findings of this economic evaluation suggest that SC insulin aspart is dominant vs IV regular insulin in the management of mild uncomplicated DKA in children. American Medical Association 2022-09-06 /pmc/articles/PMC9449786/ /pubmed/36066894 http://dx.doi.org/10.1001/jamanetworkopen.2022.30043 Text en Copyright 2022 Bali IA et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Bali, Ibrahim Abdulaziz Al-Jelaify, Muneera Rashid AlRuthia, Yazed Mulla, Jaazeel Zohair Amlih, Dana Fawzi Bin Omair, Alanoud Ibrahim Al Khalifah, Reem Abdullah Estimated Cost-effectiveness of Subcutaneous Insulin Aspart in the Management of Mild Diabetic Ketoacidosis Among Children |
title | Estimated Cost-effectiveness of Subcutaneous Insulin Aspart in the Management of Mild Diabetic Ketoacidosis Among Children |
title_full | Estimated Cost-effectiveness of Subcutaneous Insulin Aspart in the Management of Mild Diabetic Ketoacidosis Among Children |
title_fullStr | Estimated Cost-effectiveness of Subcutaneous Insulin Aspart in the Management of Mild Diabetic Ketoacidosis Among Children |
title_full_unstemmed | Estimated Cost-effectiveness of Subcutaneous Insulin Aspart in the Management of Mild Diabetic Ketoacidosis Among Children |
title_short | Estimated Cost-effectiveness of Subcutaneous Insulin Aspart in the Management of Mild Diabetic Ketoacidosis Among Children |
title_sort | estimated cost-effectiveness of subcutaneous insulin aspart in the management of mild diabetic ketoacidosis among children |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9449786/ https://www.ncbi.nlm.nih.gov/pubmed/36066894 http://dx.doi.org/10.1001/jamanetworkopen.2022.30043 |
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