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Assumptions used in estimating a population benchmark

The assumptions used in estimating a population benchmark for the uptake of insulin pump therapy of 53 per 100,000 population is based on the following sources of information:

  • current practice on the proportion of the population with diagnosed type 1 diabetes
  • published research on the likely uptake of insulin pump therapy.

Current practice

IMS Disease Analyzer is a database that holds data from a sample of GP practice systems[1]. The prevalence of diagnosed type 1 diabetes in England in 2010/11 was calculated from this data. The results of the analysis suggests that the prevalence of type 1 diabetes in the population aged younger than 12 years is 0.10%, and is 0.47% in the population aged 12 years and older. This equates to a prevalence of type 1 diabetes across all age groups of 0.43%.

Published research

Access and provision of insulin pump therapy is variable across England and the estimated uptake is lower than elsewhere in Europe[2]. The NICE costing template for TA151 on insulin pump therapy suggests that the uptake of insulin pump therapy in the population aged younger than 12 years with type 1 diabetes could be between 15% and 50% (a midpoint of 33% has been selected for the for the benchmark). The uptake of insulin pump therapy in the population aged 12 years and older with type 1 diabetes could be between 8% and 15% (a midpoint of 12% has been selected for the benchmark). This equates to an uptake of insulin pump therapy of between 8% and 16% across all age groups with type 1 diabetes.

The public health observatory Insulin Pump Audit (2009) estimated the use of insulin pumps to be significantly below these figures. The audit reported that of the prevalent population, 8% of children (aged under 18) were using insulin pumps and around 2% of adults (aged 18 years or older) were using insulin pumps. The audit did suggest that the uptake of insulin pumps may be increasing in adults, with many adults having used insulin pumps for less than two years. Of the adults included in the audit, 18% had been using an insulin pump for less than a year. A further 20% have been using an insulin pump for more than one year but less than two years.

Expert clinical opinion

The consensus opinion of the topic-specific advisory group was that the benchmark rate provided within this commissioning guide should not be interpreted as a definitive limit on the number of people who are clinically eligible, and likely to take up, insulin pump therapy. Commissioners should ensure that services are operating within NICE criteria so that people who are eligible for insulin pump therapy have access to them.

Conclusions

Based on the information outlined above, it is concluded that benchmark rates for the uptake of insulin pump therapy is:

  • Approximately 33% uptake of insulin pump therapy in the population with type 1 diabetes aged younger than 12 years. This equates to around 33 per 100,000 population aged younger than 12 years.
  • Approximately 12% uptake of insulin pump therapy in the population with type 1 diabetes aged 12 years and older. This equates to around 60 per 100,000 population aged 12 years and older.

Overall it is calculated that 12.4% uptake of insulin pump therapy in the population of with type 1 diabetes across all age groups. This equates to around 53 per 100,000 across all groups.

The benchmark of 12.4% uptake of insulin pump therapy across all age groups with type 1 diabetes is estimated to be a five- to sixfold increase in the current provision of insulin pump therapy by the NHS in England.

Use the insulin pump therapy service commissioning and benchmarking tool to determine the level of service that might be needed locally and to calculate the cost of commissioning the service using the indicative benchmark and/or your own local data.

Commissioners should use their local needs assessment to determine optimum levels for local service provision. Commissioners should note that the benchmark rates do not represent NICE's view of desirable, or maximum or minimum, service levels.

Commissioners should use this benchmark and local data to facilitate local discussion on optimum service levels. There is considerable variation in the number of people with diabetes. This is influenced by the social, economic and demographic profile of the local population, therefore commissioners are encouraged to consider local assumptions.



[1] IMS collects data from a sample of GP practice systems. Around 100 are currently delivering data and the database has about 2.7 million patient records, almost 1 million of which were registered for the whole of the study year. These records are anonymised and are available for analysis via a tool called Disease Analyzer. The sample includes practices from England, Wales, Scotland and Northern Ireland and has a representative UK sample by age and sex. Disease Analyzer data have been collected from a stable panel over a period of more than 14 years. The database holds significant clinical events relating to any period in a patient's life where summarised into computer records by the practice. As in any observational database, data entered by panel doctors may be incomplete.

[2] Department of Health (2007) Insulin pump services: report of the Insulin Pumps Working Group. London: Department of Health.

This page was last updated: 03 April 2012

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.