Cost-Effectiveness of CSII versus MDI in Children and Adolescents with Type 1 Diabetes: A Meta-Analysis
cilt.7, sa.1, ss.13-20, 2026 (Hakemli Dergi)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 7 Sayı: 1
- Basım Tarihi: 2026
- Doi Numarası: 10.29228/tjhealthsport.82940
- Derginin Tarandığı İndeksler: Academic Search Ultimate (EBSCO), CINAHL, EMBASE
- Sayfa Sayıları: ss.13-20
- Acıbadem Mehmet Ali Aydınlar Üniversitesi Adresli: Evet
Özet
Abstract Objective: Continuous subcutaneous insulin infusion (CSII) is a pump-mediated insulin delivery modality used as an alternative to Multiple Daily Injections (MDI) in children and adolescents diagnosed with type 1 diabetes (T1D). Although the clinical benefits of CSII have been documented, there is limited evidence providing a joint analysis of clinical and economic outcomes. The aim of this study was to evaluate both clinical (glycemic control measured by HbA1c) and economic outcomes associated with CSII and MDI in a pediatric/adolescent patient population diagnosed with T1D using meta-analysis. Materials and Methods: A random-effects model was applied to synthesize the pooled estimates. Six eligible studies were included. Pooled standardized mean differences (SMDs) were calculated for HbA1c. Heterogeneity was assessed using I², τ², and Cochran’s Q test. The effects of publication year, country, and diabetes duration were evaluated using moderator analyses. Publication bias was assessed using the Egger test, funnel plots, and trim-and-fill analysis. The robustness of pooled estimates was assessed using sensitivity analyses of leaving out individual studies to examine their effect. The stability of statistical significance was also assessed using safe N analyses. Six studies met the inclusion criteria. Results: The pooled standardized mean difference demonstrated that CSII was associated with significantly lower HbA1c levels compared with MDI (SMD = −1.50; 95% CI −2.78 to −0.21; p < 0.0001). A significant degree of heterogeneity was observed (I² = 99.23%). Country-level differences explained 62.26% of the heterogeneity. CSII provides better QALYs than MDI and is a cost-effective option in most scenarios. Conclusion: CSII provides clinically significant improvements in glycemic control compared to MDI in children and adolescents with T1D. Keywords: Type 1 diabetes, Cost-effectiveness, Continuous subcutaneous insulin infusion, Multiple daily injections