Cost-effectiveness of insulin analogs from the perspective of the Brazilian public health system

Abstract

Human insulin is provided by the Brazilian Public Health System (BPHS) for the treatment of diabetes, however, legal proceedings to acquire insulin analogs have burdened the BPHS health system. The aim of this study was to perform a cost-effectiveness analysis to compare insulin analogs and human insulins. This is a pharmacoeconomic study of cost-effectiveness. The direct medical cost related to insulin extracted from the Ministry of Health drug price list was considered. The clinical results, i.e. reduction in glycated hemoglobin (HbA1c), were extracted by meta-analysis. Different scenarios were structured to measure the uncertainties regarding the costs and reduction in HbA1c. Decision tree was developed for sensitivity of Incremental Cost Effectiveness Ratio (ICER). A total of fifteen scenarios were structured. Given the best-case scenario for the insulin analogs, the insulins aspart, lispro, glargine and detemir showed an ICER of R$ 1,768.59; R$ 3,308.54; R$ 11,718.75 and R$ 2,685.22, respectively. In all scenarios in which the minimum effectiveness was proposed, lispro, glargine and detemir were dominant strategies. Sensitivity analysis showed that the aspart had R$ 3,066.98 [95 % CI: 2339.22; 4418.53] and detemir had R$ 6,163.97 [95% CI: 3919.29; 11401.57] for incremental costs. We concluded there was evidence that the insulin aspart is the most cost-effective.

InsulinAPP application protocol for the inpatient management of type 2 diabetes on a hospitalist-managed ward: a retrospective study

“…Our hospital is a public hospital that is part of the Brazilian national unified public health system ( Sistema Único de Saúde – SUS) ( 17 ), in which human insulins (NPH and regular) are the standard treatment defined by the Brazilian Ministry of Health ( 30 ). Pharmacoeconomic studies that evaluated human insulins and insulin analogues have suggested that the use of human insulins are the best options in relation to the cost of treatment ( 31 , 32 ). However, the majority of inpatient insulin therapy studies have been performed with insulin analogues.…”

Evaluating the Impact of Intensifying Treatment from Human to Analogue Insulin on Glycaemic Control and Insulin Expenditure in Patients with Type 2 Diabetes: A Retrospective Cohort Study

“…Users of analogue insulin via pen devices showed better adherence, and this type of insulin was more cost-effective. A pharmacoeconomic study conducted in Brazil in 2017 ( 21 ) concluded that human insulins were the best treatment option for diabetes mellitus based on direct cost analysis.…”