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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...

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Autores principales: Bali, Ibrahim Abdulaziz, Al-Jelaify, Muneera Rashid, AlRuthia, Yazed, Mulla, Jaazeel Zohair, Amlih, Dana Fawzi, Bin Omair, Alanoud Ibrahim, Al Khalifah, Reem Abdullah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2022
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.
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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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