Open Access Open Badges Research article

Economic evaluation of continuous subcutaneous insulin infusion for children with diabetes - a pilot study: CSII application for children – economic evaluation

Elina Petkova1, Valentina Petkova1*, Maia Konstantinova2 and Guenka Petrova1

Author Affiliations

1 Department of Social Pharmacy, Medical University Sofia, Faculty of Pharmacy, Sofia, Bulgaria

2 Medical University Sofia, University Pediatric Hospital, Endocrinology Clinic, Sofia, Bulgaria

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BMC Pediatrics 2013, 13:155  doi:10.1186/1471-2431-13-155

Published: 1 October 2013



The objective of this study is to assess the cost of using continuous subcutaneous insulin infusion to treat children with type-1diabetes in Bulgaria, considering changes in body mass index (BMI) and the glycated hemoglobin. The study was performed from the perspective of the Bulgarian National Health Insurance Fund (NHIF) and patients.


A total of 34 pediatric type-1-diabetes patients were observed for 7 months, divided into 2 groups – on pumps and on insulin analogue therapy. Patient demographic data, BMI and glycated hemoglobin level were obtained and recorded. The cost of insulin, pumps, and consumables were calculated and compared with changes in glycated hemoglobin level. The incremental cost-effectiveness ratio was below the threshold value of gross domestic product per capita.


The results were sensitive to changes in glycated hemoglobin level. Improvements associated with glycemic control led to a reduced glycated hemoglobin level that could ensure good diabetes management, but its influence on BMI in growing children remains unclear.


Continuous subcutaneous insulin infusion appears to be more cost-effective for the Bulgarian pediatric population and health care system.

Pediatric diabetes; Continuous subcutaneous insulin infusion (CSII); Insulin analogues; Cost-effectiveness analysis