Cost-effectiveness of insulin aspart compared to human insulin in pregnant women with type 1 diabetes in the UK

Lloyd, Adam; Townsend, C; Munro, Vicki; Twena, N; Nielsen, S; Holman, AJ

doi:10.1185/03007990802668208

Cited by 11 publications

(3 citation statements)

References 10 publications

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“…We expand on this point qualitatively by comparing studies of screening for and treatment of diabetes in pregnant women [16][17][18][19][20][21][22][23] with those on prenatal genetic testing for pregnant women. [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Better treatment of diabetes and better glucose control during pregnancy have as one of their intended effects the prevention of miscarriage.…”

Section: Theme 2: Studies Select Outcomes For Inclusion That Tend To mentioning

confidence: 99%

“…We examined a variety of interventions intended to address health conditions in women and men that could affect pregnancy or fertility outcomes. We first examined studies where improved pregnancy or fertility outcomes were an intended effect beyond the main effect of improving a woman's health; they included treatment of preeclampsia and diabetes and smoking cessation in pregnant women (3 articles, [82][83][84] 8 articles, [16][17][18][19][20][21][22][23] and 11 articles, [43][44][45][46][47][48][49][50][51][52][53] respectively) and treatment of diabetes and smoking cessation in women intending to become pregnant (3 articles [85][86][87] and 1 article, 88 respectively). For the studies targeting pregnant women, maternal QALYs from intended health effects were often considered, while QALYs resulting from having live and healthy offspring were sometimes but not always included.…”

Section: Genetic Testing Of Pregnant Women and Their Fetusesmentioning

confidence: 99%

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Evaluating Cost-effectiveness of Interventions That Affect Fertility and Childbearing

Goldhaber-Fiebert

Brandeau

2015

Med Decis Making

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Background Current guidelines for economic evaluations of health interventions define relevant outcomes as those accruing to individuals receiving interventions. Little consensus exists on counting health impacts on current and future fertility and childbearing. Objective To characterize current practices for counting such health outcomes. Design We developed a framework characterizing health interventions with direct and/or indirect effects on fertility and childbearing and how such outcomes are reported. We identified interventions spanning the framework and performed a targeted literature review for economic evaluations of these interventions. For each article, we characterized how the potential health outcomes from each intervention were considered, focusing on QALYs associated with fertility and childbearing. Results We reviewed 108 studies, identifying seven themes: 1) Studies were heterogeneous in reporting outcomes. 2) Studies often selected outcomes for inclusion that tend to bias toward finding the intervention to be cost-effective. 3) Studies often avoided the challenges of assigning QALYs for pregnancy and fertility by instead considering cost per intermediate outcome. 4) Even for the same intervention, studies took heterogeneous approaches to outcome evaluation. 5) Studies employed multiple, competing rationales for whether and how to include fertility-related QALYs and whose QALYs to include. 6) Studies examining interventions with indirect effects on fertility typically ignored such QALYs. 7) Even recent studies had these shortcomings. Limitations The review was targeted rather than systematic. Conclusions Economic evaluations inconsistently consider QALYs from current and future fertility and childbearing in ways that frequently appear biased towards the interventions considered. As the Panel on Cost-Effectiveness in Health and Medicine updates its guidelines, making the practice of cost-effectiveness analysis more consistent is a priority. Our study contributes to harmonizing methods in this respect.

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Section: Theme 2: Studies Select Outcomes For Inclusion That Tend To mentioning

confidence: 99%

Section: Genetic Testing Of Pregnant Women and Their Fetusesmentioning

confidence: 99%

Evaluating Cost-effectiveness of Interventions That Affect Fertility and Childbearing

Goldhaber-Fiebert

Brandeau

2015

Med Decis Making

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“…The extra cost of pre-term delivery was calculated to explore the cost-effectiveness of using insulin aspart. Overall the cost of using insulin aspart was £3222 compared to £3539 for human Volume insulin making the use of insulin aspart in women with type 1 diabetes cost effective [28].…”

Section: Rapid Acting Insulin Analoguesmentioning

confidence: 99%

The use of insulin analogues in pregnancy

Lambert

Holt

2013

Diabetes Obesity Metabolism

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Excellent glycaemic control is essential in pregnancy to optimise maternal and foetal outcomes. The aim of this review is to assess the efficacy and safety of insulin analogues in pregnancy. Insulin lispro and insulin aspart are safe in pregnancy and may improve post-prandial glycaemic control in women with type 1 diabetes. However, a lack of data indicating improved foetal outcomes would suggest that there is no imperative to switch to a short-acting analogue where the woman's diabetes is well controlled with human insulin. There are no reports of the use of insulin glulisine in pregnancy and so its use cannot be recommended. Most studies of insulin glargine in pregnancy are small, retrospective and include women with pre-existing diabetes and gestational diabetes. There appear to be no major safety concerns and so it seems reasonable to continue insulin glargine if required to achieve excellent glycaemic control. A head-to-head comparison between insulin detemir and NPH insulin in women with type 1 diabetes showed that while foetal outcomes did not differ, fasting plasma glucose improved with insulin detemir without an increased incidence of hypoglycaemia. The greater evidence base supports the use of insulin detemir as the first line long-acting analogue in pregnancy but the lack of definitive foetal benefits means that there is no strong need to switch a woman who is well controlled on NPH insulin. There seems little justification in using long acting insulin analogues in women with gestational diabetes or type 2 diabetes where the risk of hypoglycaemia is low.

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Different insulin types and regimens for pregnant women with pre-existing diabetes

O’Neill

Kenny

Khashan

et al. 2017

Cochrane Database of Systematic Reviews

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Cost-effectiveness of insulin aspart compared to human insulin in pregnant women with type 1 diabetes in the UK

Abstract: C o p y r i g h t I n f o r m a U K L i m i t e d 2 0 0 9 N o t f o r S a l e o r C o m e r c i a l D i s t r i b u t i o n U n a u t h o r i z e d u s e p r o h i b i t e d . A u t h o r i s e d u s e r s c a n d o w n l o a d ,

Cited by 11 publications

References 10 publications

Evaluating Cost-effectiveness of Interventions That Affect Fertility and Childbearing

Evaluating Cost-effectiveness of Interventions That Affect Fertility and Childbearing

The use of insulin analogues in pregnancy

Different insulin types and regimens for pregnant women with pre-existing diabetes

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