OBJECTIVES: Adequate insulin injection technique (ITT) is crucial to optimize the efficacy of diabetes therapy. The presence of widespread non-practice of injection site rotation and frequent reuse of insulin pen needles (PN) promote high rates of lipohypertrophy (LH) among people living with diabetes (PwD). LH has been associated with elevated daily insulin requirement and suboptimal insulin absorption leading to worsened glycemic control and increased risk for hypoglycemia. In addition to intensified education on injection technique, it has been shown that lower out-of-pocket patient expenditure can reduce the rate of PN reuse, which will have positive effects on the management of PwD and lower the corresponding economic burden.

METHODS: A modelling framework was developed to estimate the impact of a behavior shift in reuse on clinical and economic outcomes for type 1 and insulin-treated type 2 PwD in Belgium. Patient populations were characterized by treatment-specific characteristics and grouped according to frequency of PN replacement. Provisioning of PN together with intensified educational support was modelled to cause a change in the reuse frequency distribution, with the effects propagating downstream the model. Model and input parameters were based on a narrative literature research and expert opinions obtained from a Delphi panel, since available data was found to be limited, incomplete or inconsistent.

RESULTS: Using the current situation as comparator, this analysis showed a reduction of healthcare expenditures following an improved adherence to ITT recommendations. Considering a 3-year time horizon, this study yields potential savings of 27.8 million euros (14.9 – 41.2 million euros) when 55% of PwD improve PN reuse behavior, with hypoglycemic events representing the largest contribution to cost savings.

CONCLUSIONS: This in-depth analysis shows that even in an era of technological advances and established diabetes care, non-adherence to correct ITT has an important impact on economic and health outcomes of PwD in Belgium.