Cost-effectiveness of basal insulin from a US health system perspective: Comparative analyses of detemir, glargine, and NPH

Abstract

The purpose of this study was to compare in clinical and economic terms the long-acting insulin analogue detemir with intermediate-acting Neutral Protamine Hagedorn (NPH) insulin and with long-acting insulin glargine. Investigators used the validated Center for Outcomes Research (CORE) Diabetes Model to project clinical and cost outcomes over a 35-year base case time horizon; outcome data were extracted directly from randomized, controlled trials designed to compare detemir with NPH and with insulin glargine. Modeled patient characteristics were derived from corresponding trials, and simulations incorporated published quality-of-life utilities with cost data obtained from a Medicare perspective. Detemir, when compared with NPH, increased quality-adjusted life expectancy by 0.698 quality-adjusted life-years (QALYs). Lifetime direct medical costs were increased by 10,451 dollars per patient, although indirect costs were reduced by 4688 dollars. On the basis of direct costs, the cost per QALY gained with detemir was 14,974 dollars. In comparison with glargine, detemir increased quality-adjusted life expectancy by 0.063 QALYs, reduced direct medical costs by 2072 dollars per patient, and decreased indirect costs by 3103 dollars (dominant). Reductions in diabetes-related comorbidities were also associated with detemir in both instances, most notably in the complications of retinopathy and nephropathy. Relative reductions in rates of complications were greatest in the comparison of detemir with NPH. Results were most sensitive to variation in hemoglobin A1c (HbA1c) levels. However, variation among any of the key assumptions, including HbA1c, did not alter the relative results. Detemir represents an attractive clinical and economic intervention in the US health care setting compared with both NPH insulin and insulin glargine.

Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence

“…123 Hence, potential therapeutic benefits associated with lower rates of hypoglycemic episodes and improved PPG and FPG control might be expected to offset the higher initial medication costs of insulin analogs. A number of U.S. health economic modeling studies have carried out this type of analysis comparing detemir, glargine, and NPH insulins, 124 insulin glargine and reference therapy, 125 and insulin lispro and regular insulin. 126,127 General conclusions from these studies suggest that total direct healthcare costs may be relatively similar between insulin analog and older insulin treatments, while treatment with insulin analogs may be associated with increases in quality-adjusted life expectancy.…”

Insulin analogs for the management of type 2 diabetes

“…16 A comparison of the direct costs of insulin detemir and insulin glargine (2006 data) indicated that costs were $2,072 less with the former (the indirect costs were also $3,103 less per patient for those receiving insulin detemir, indicating a total difference of $5,175). 16 Clinical trials.…”

Insulin glargine: a basal insulin for the management of diabetes

“…In another study comparing detemir and NPH with insulin glargine, however, insulin detemir seemed to be a more attractive option [50]. The investigators used the Center for Outcomes Research Diabetes Model to project clinical and cost outcomes over 35 years, with data extracted from randomized, controlled trials.…”