• Elina Petkova Faculty of Pharmacy-Sofia, Medical University of Sofia
  • Valentina Petkova Faculty of Pharmacy-Sofia, Medical University of Sofia
  • Guenka Petrova Faculty of Pharmacy-Sofia, Medical University of Sofia
  • Maya Konstantinova Pediatric Endocrinology Clinic-Sofia, Medical University of Sofia
Keywords: Pediatric diabetes, continuous subcutaneous insulin infusion (CSII), multiple daily injections, human insulin, cost-effectiveness analysis


The aim of this study is to evaluate the cost-effectiveness of  continuous subcutaneous insulin infusion (CSII) to multiple daily insulin injection (MDI) either with analogues or with human insulin, based on the achieved therapeutic results such as changes in glycated hemoglobin level (HbA1c) in the various therapies. The study was performed with children with type-1 diabetes in Bulgaria. The objective of this study was to serve for the Bulgarian National Health Fund (NHIF).

Methods: A combined retrospective and prospective study was performed at the Endocrinology diabetes and genetic diseases clinic.51 children with type-1 diabetes were observed for 7 months diveded into three group: Group 1- on continuous subcutaneous insulin infusion (CSII); Group 2- on multiple daily insulin analogues injections (MDI) and Group 3 – on human insulin (HI).Patient demographic data, age, sex, weight, duration of disease, HbA1c – values before the start of the study and after the end of the observation and type of treatment (CSII; MDI or HI) were observed. Cost-effectiveness, sensitivity and statistical analyses are applied to studied long-term therapeutic results.

Results: The three groups of observed children do not differ statistically in age and gender. Most of the participants in Group 1 and Group 2 have suffered from diabetes from 5,6 years. The duration of diabetes was lower in the group of human insulin. All studied children are treated. By all of them the results of the treatment improved, but in the Group 1 the improvement of HbA1c is the highest. The average improvement of HbA1c in the Group 1 after the CSII introduction is 1.85, while after the application of analogue insulin is 0,59 and 0,28 respectively in the Group 3 after the treatment on human insulin.The cost of insulin pump, consumables- infusion set and insulin reservoir, blood glucose monitoring system, strips, needles and insulin cost was calculated.The total cost ot the treatment of diabetes with insulin pump for 7 months is 2358,85Euro; 856,98 Euro in the Group 2 on MDI and 744,24 Euro for 7 months in the Group 3 on human insulin.The differences in costs and therapeutic results permit to conduct cost- effectiveness analysis by comparing of the three alternatives.Our study shows that the CSII pumps allows better diabetes control compared to the treatment with analogue insulin and human insulin. Insulin pumps are also cost- effectiveness alternative for children with type 1 diabetes.


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