Sunday, March 6, 2011

Islet cell transplants can be cost effective as well as increase the quality of life- a study

I recently found this abstract and thought it was very interesting and exciting.  I was able to get a copy of the entire article from a friend, thanks Jason, but can't print all of it due to copyright laws.  I am going to attempt to write about the highlights of what this shows.

A health economic analysis of clinical islet transplantation


  • cost;
  • cost-effectiveness analysis;
  • economic model;
  • health economics;
  • islet cell transplantation
Beckwith J, Nyman JA, Flanagan B, Schrover R, Schuurman H-J. A health economic analysis of clinical islet transplantation. Clin Transplant 2011 DOI: 10.1111/j.1399-0012.2011.01411.x. © 2011 John Wiley & Sons A/S.
Abstract:  Islet cell transplantation is in clinical development for type 1 diabetes. There are no data on the cost in relationship to its benefits. We performed a cost-effectiveness analysis and made a comparison with standard insulin therapy, using Markov modeling and Monte Carlo simulations. The patient population was adults aged 20 yr suffering from hypoglycemia unawareness. Data were estimates from literature and clinical trials: costs were based on the situation in the United States. For insulin therapy, cumulative cost per patient during a 20-yr follow-up was $663 000, and cumulative effectiveness was 9.3 quality-adjusted life years (QALY), the average cost-effectiveness ratio being $71 000 per QALY. Islet transplantation had a cumulative cost of $519 000, a cumulative effectiveness of 10.9 QALY, and an average cost-effectiveness ratio of $47 800. During the first 10 yr, costs for transplantation were higher, but cumulative effectiveness was higher from the start onwards. In sensitivity analyses, the need for one instead of two transplants during the first year did not affect the conclusions, and islet transplantation remained cost-saving up to an initial cost of the procedure of $240 000. This exploratory evaluation shows that islet cell transplantation is more effective than standard insulin treatment, and becomes cost-saving at about 9–10 yr after transplantation.

This study has attempted to compare the cost of managing Type 1 diabetes by intense insulin therapy to the cost of intervention with an islet cell transplant.  Also woven into the design is how both affect the quality of life.

It begins with data on islet cell graft survival.  I converted their graph into a chart.
one year results:     full function= 93%         partial function= 8%         no function= 0%
five year results:      full function= 47%         partial function= 37%       no function= 17%
ten year results:       full function= 27%        partial function= 49%        no function= 24%  
This shows that most recipients make it to one year, and half make it to five years with no insulin.
And that half make it to ten years with at least partial function.
This is very positive.  Its personally disappointing to me because I am behind the curve.  I only made it 2 years with no insulin, but it gives me hope that I will remain where I am for awhile which is still at a very good place.  This data reflects what I notice from the cast of characters on the islet cell recipient facebook page as well.

The Quality of life variable was very complicated and I am going to simplify it greatly.  It was comparing how the hardships of each treatment affected the quality of the patient's life. The values ranged from 0 which is worst to 1 which is best.  The values that I thought the most interesting were:
A healthy person aged 25-34 had a quality of life valued at 0.91
A diabetic aged 25-34 had a quality of life valued at 0.81    If this person had hypoglycemic unawareness, which all recipients do, a reduction of 0.06 put this pt at a 0.75 quality of life.
From here, adjustments were made base on diabetes causing complications that the insulin group would face, and side effects and graft failure issues that the transplant group would face. A graph shows a mostly parallel line with the transplant group slightly ahead of the insulin group.

Then came the cost analysis.  The numbers themselves were stunning.
Cost of the organ procurement was $25,000.
Cost of harvesting the islets was $20,000.  with a 50% success rate means $40,000.
Cost of immunosuppression was about $1400/month
Cost of transplant was $93,500.  Each successive year was $19,000.
Cost of insulin therapy/year was $6,600.   The cost of having complications varied from $106,000 for renal failure to $1,400 for neuropathy.

Combining these two variables shows that initially the transplant is more costly.  But, over time, as the cost of the transplant stabilizes, the cost of insulin therapy and its long term complications increases.  This study covered a span of 20 years.  At about 9 years, the costs intersect and the islet cell transplant remains the lower cost option.
Interesting numbers here were:   
20 year cost of insulin therapy was $663,000.  Quality of life years gained was 9.1.
20 year cost of islet cell transplant was $519,000.  Quality of life years gained was 10.9  

The article goes into much more detail, but these are the highlights.  It also includes a discussion about how the transplant procedure is expected to improve.  This has already proven to be true in that due to a change in an enzyme used in the harvesting procedure, more islets are now obtained per pancreas than when I had my transplant in 2008.  And there is much more on the horizon............


cinglis said...

Hi Kathy your as passionate for a cure for all diabetes as islet cell has given hope to all candidate's and recipients."hope"

wmahmood said...

Kathy at least it helped for two years. However, is the procedure repeatable so you can have it again to see if you last longer than 2 years free of insulin.

I read about ISLET cell transplants but it all seems to be US and Canada based. Is there anything being done in Europe... From a concerned parent of an 7year old boy who is type diabetic and not holding up much hope in the British social medical care where accountants seem to rule the world.

Kathy said...

The procedure would be repeatable, but as of now you can only get islet cell transplants as a clinical trial in the US. And most of the trials say that there must be certain time range for a second transplant. Mine was 6 months, and at that time, I was doing great.

In Canada, it is possible to get additional transplants with no time restraints. Hopefully, it will be that way here soon.

There are islet cell transplant centers in Europe. I'm not what the research protocols include there, but I don't think that any place does kids. Yet. And the way that the research is progressing and getting better, it is well worth his while to wait. Keep him healthy and when he is old enough, he will probably get treatment that far exceeds what is available today. Best of luck to you and your son.