Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Martin G. Les pompes à insuline dans le traitement du diabète de type 1. [Insulin pumps in the treatment of type 1 diabetes] Quebec: Institut national d'excellence en sante et en services sociaux (INESSS). Note informative. 2015 Authors' conclusions This information brief is intended to inform the ministère de la Santé et des Services sociaux (MSSS) concerning reimbursement for insulin pumps in the treatment of type 1 diabetes. After the launch of the Insulin Pump Access Program in 2011, the MSSS asked to be updated on the state of the evidence on these medical instruments that deliver continuous subcutaneous insulin infusion. In particular, the MSSS wanted to know about the effectiveness of insulin pumps for the pediatric and adult populations in relation to the most common treatment modality: multiple daily insulin injections with a syringe or pen.
A literature review was therefore performed on the clinical effectiveness of insulin pumps (excluding, in particular, the concept of quality of life), on economic aspects and on the medical eligibility criteria for public funding for insulin pumps. Funding programs for insulin pumps implemented in the other Canadian provinces and territories were also examined and the main criteria they use are listed. Examples include the age of the person with type 1 diabetes and the frequency of hypoglycemia and ketoacidosis events.
Generally, the studies comparing the effectiveness of multiple insulin injections and continuous subcutaneous insulin infusion delivered by pumps presented results
• that did not differ statistically between these two treatment modalities;
• for which the statistical significance was not specified; or
• that were contradictory across the studies.
While it is true that statistically significant improvements were obtained with insulin pumps in relation to certain parameters, such as glycosylated hemoglobin rate, this finding nevertheless needs to be qualified. In fact, the number of studies analyzed was low, the study populations were heterogeneous, in addition to being small in number, and the study periods were relatively short. Even though the difference in effectiveness between insulin pumps and multiple injections was statistically significant, it is also important to state that it was not necessarily clinically significant. In fact, in the majority of the cases in which clinical significance was assessed, the results were not clinically significant.
In the same vein, the review of the economic literature showed that the evidence was weak. In fact, only two assessment reports were selected and the authors of both indicated that the studies analyzed had methodological weaknesses. Indexing Status Subject indexing assigned by CRD MeSH Blood Glucoses; Diabetes Mellitus, Type 1; Hypoglycemic Agents; Infusion Pumps, Implantable; Insulin Country of organisation Canada English summary An English language summary is available. Address for correspondence Institut national d'excellence en santé et en services sociaux (INESSS), 1195 avenue Lavigerie, bureau 60 Québec (Québec) Canada, G1V 4N3
Email: inesss@inesss.qc.ca AccessionNumber 32015000780 Date abstract record published 17/06/2015 |