Differences in hypoglycemia event rates and associated cost-consequence in patients initiated on long-acting and intermediate-acting insulin products

Bullano, Michael F.; Al‐Zakwani, Ibrahim; Fisher, Mary L.; Menditto, Laura; Willey, Vincent J.

doi:10.1185/030079905x26234

Cited by 46 publications

(30 citation statements)

References 16 publications

(17 reference statements)

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“…Two of these analyses showed that the higher prescription cost of glargine was more than offset by a lower number of hypoglycaemic events (Table 4). 48,49 Data from Zhang and Menditto 50 are consistent with these reports, and likewise indicate higher prescription costs but greater cost savings when reduced costs are factored into the evaluation for inpatient claims related to hypoglycaemia treatments and total costs for inpatient diabetes care.…”

Section: Studies Of Analogues Versus Human Insulinsupporting

confidence: 78%

Is the use of insulin analogues cost-effective?

Leichter¹

2008

Adv Therapy

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Many patients with diabetes fail to achieve their glycaemic targets despite clear evidence that glycaemic control can prevent or delay the development of costly complications in diabetes. This article describes how insulin analogues (insulins lispro, aspart, glulisine, glargine and detemir) may have a role to play in overcoming barriers to insulin acceptance and improving adherence with therapy, and examines their cost-effectiveness as determined in published studies. Cost-effectiveness studies attempt to assess all the costs and all the benefits of a particular therapy. Pharmacoeconomic models, which calculate the long-term effect of interventions, show that over periods such as 10 or 35 years the higher prescription costs of analogues are offset by a lower incidence of acute hypoglycaemic events and costly, chronic complications such as nephropathy. This results in costs per 'quality-adjusted life year' that fall well within accepted limits for good value for money. Retrospective analyses of managed care databases show that higher prescription costs for analogues are offset by lower hypoglycaemia-related costs and/or inpatient claims. Relative to human insulins, analogues provide a better balance between glycaemic control and tolerability. Patients' fear of hypoglycaemia is allayed; the pen devices used with analogues facilitate insulin injection; and the pharmacokinetic characteristics lead to increased flexibility and convenience. All these factors can help increase adherence with therapy, which may in itself be cost-saving. Taken overall, these results indicate that insulin analogues are a cost-effective therapy.

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Section: Studies Of Analogues Versus Human Insulinsupporting

confidence: 78%

Is the use of insulin analogues cost-effective?

Leichter¹

2008

Adv Therapy

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“…Placing these findings in a wider context, there have been a number of other studies using observational data [13][14][15][16] . In general, though, the results using observational data were generally stronger than those seen in the randomised clinical trials.…”

Section: Discussionmentioning

confidence: 99%

The outcome of care in people with type 1 and type 2 diabetes following switching to treatment with either insulin glargine or insulin detemir in routine general practice in the UK: a retrospective database analysis

Currie

Poole

Tetlow

et al. 2007

Current Medical Research and Opinion

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around 300 GP practices) using standard statistical methods. A detailed description of each patient was available for up to 15 years that included their diagnoses, test results and treatments. The two alternative treatments were compared for 9 months following switching to one of these treatments by quarterly periods. The primary outcome measure was change in HbA 1c , whilst secondary measures were change in weight, reported hypoglycaemia and treatment discontinuation. Subjects were split by type of diabetes.Results: Data were available for 694 people treated with detemir and 5683 people treated with glargine. The demographic and clinical profiles of the respective groups were almost identical. There was a notable improvement in HbA 1c following treatment switching to either glargine or detemir; however, there was a trend for improved diabetes control with glargine in both type 1 and type 2 diabetes. Glargine resulted in less hypoglycaemia (relative risk = 0.75; p < 0.05). Detemir resulted in a trend for less weight gain, but this did not achieve statistical significance. There was no convincing evidence of a difference in treatment discontinuation patterns.Conclusion: On balance, glargine showed marginal improvement over detemir in diabetesrelated outcomes. There was a marked improvement in hypoglycaemia when treated with glargine over detemir.

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“…84 -88 While it is beyond the scope of this article to discuss the details of each study, the majority of these studies concluded that the initial cost increases caused by the initiation of insulin analog therapy are likely to be offset by the long-term reductions in the occurrence of hypo- glycemia and diabetes-related complications, which in turn may result in lower health care utilization and expenditures. 87,88 …”

Section: Insulin Therapymentioning

confidence: 98%

Optimizing Insulin Use in Type 2 Diabetes: Role of Basal and Prandial Insulin in Long-Term Care Facilities

Haas

2007

Journal of the American Medical Directors Association

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Differences in hypoglycemia event rates and associated cost-consequence in patients initiated on long-acting and intermediate-acting insulin products

Cited by 46 publications

References 16 publications

Is the use of insulin analogues cost-effective?

Is the use of insulin analogues cost-effective?

The outcome of care in people with type 1 and type 2 diabetes following switching to treatment with either insulin glargine or insulin detemir in routine general practice in the UK: a retrospective database analysis

Optimizing Insulin Use in Type 2 Diabetes: Role of Basal and Prandial Insulin in Long-Term Care Facilities

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