Health economic evaluations comparing insulin glargine with NPH insulin in patients with type 1 diabetes: a systematic review

Abstract

BackgroundCompared to conventional human basal insulin (neutral protamine Hagedorn; NPH) the long-acting analogue insulin glargine (GLA) is associated with a number of advantages regarding metabolic control, hypoglycaemic events and convenience. However, the unit costs of GLA exceed those of NPH. This study aims to systematically review the economic evidence comparing GLA with NPH in basal-bolus treatment (intensified conventional therapy; ICT) of type 1 diabetes in order to facilitate informed decision making in clinical practice and health policy.MethodsA systematic literature search was performed for the period of January 1st 2000 to December 1st 2009 via Embase, Medline, the Cochrane Library, the databases GMS (German Medical Science) and DAHTA (Deutsche Agentur für Health Technology Assessment), and the abstract books of relevant international scientific congresses. Retrieved studies were reviewed based on predefined inclusion criteria, methodological and quality aspects. In order to allow comparison between studies, currencies were converted using purchasing power parities (PPP).ResultsA total of 7 health economic evaluations from 4 different countries fulfilled the predefined criteria: 6 modelling studies, all of them cost-utility analyses, and one claims data analysis with a cost-minimisation design. One cost-utility analysis showed dominance of GLA over NPH. The other 5 cost-utility analyses resulted in additional costs per quality adjusted life year (QALY) gained for GLA, ranging from € 3,859 to € 57,002 (incremental cost effectiveness ratio; ICER). The cost-minimisation analysis revealed lower annual diabetes-specific costs in favour of NPH from the perspective of the German Statutory Health Insurance (SHI).ConclusionsThe incremental cost-utility-ratios (ICER) show favourable values for GLA with considerable variation. If a willingness-to-pay threshold of £ 30,000 (National Institute of Clinical Excellence, UK) is adopted, GLA is cost-effective in 4 of 6 cost utility analyses (CUA) included. Thus insulin glargine (GLA) seems to offer good value for money. Comparability between studies is limited because of methodological and country specific aspects. The results of this review underline that evaluation of insulin therapy should use evidence on efficacy of therapy from information synthesis. The concept of relating utility decrements to fear of hypoglycaemia is a plausible approach but needs further investigation. Also future evaluations of basal-bolus insulin therapy should include costs of consumables such as needles for insulin injection as well as test strips and lancets for blood glucose self monitoring.

Daily insulin doses and injection frequencies of neutral protamine hagedorn (NPH) insulin, insulin detemir and insulin glargine in type 1 and type 2 diabetes: a multicenter analysis of 51 964 patients from the German/Austrian DPV‐wiss database

“…Moreover, the pharmacokinetic profile of long‐acting insulin analogues is believed to provide the potential of reduced daily injection frequencies. This propensity may also have implications for health economical calculations . Whether these theoretical advantages are reflected in the ‘real‐life’ setting of patient care outside of randomized controlled studies is currently not known.…”

Resource Consumption and Costs of Treatment in Patients with Type 1 Diabetes under Intensified Conventional Therapy under German Real-Life Conditions

“…Some studies have shown that insulin glargine is superior to neutral protamine Hagedorn (NPH) insulin in reducing the fasting blood glucose value, the hemoglobin A1c (HbA1c) value, and the number of nocturnal hypoglycemias in T1DM patients. [10][11][12][13][14][15] Glargine appeared to be cost-effective or even cost saving among T1DM patients with basal bolus therapy from the perspective of statutory health insurance compared with NPH depending on the scenario chosen. 16 The aim of this study was to compare insulin glargine and NPH insulin, in terms of resource consumption and directly associated treatment costs, in T1DM patients receiving ICT.…”

Insulin Analogs—Are They Worth It? Yes!

“…The complexity of dealing with overall cost issues was shown in an analysis that found only 6 studies (out of 382 publications between 2000 and 2009) offered data on both the acquisition costs of glargine versus NPH in patients with type 1 diabetes but also on clinical effects, diabetes complications, quality of life, fear of hypoglycemia, etc. (22). In one study, glargine was less expensive and in four additional studies use of glargine was deemed "good value" (i.e., cost $4,420-$17,946; 3,227-13,100 euro per quality-adjusted life-years gained) (23).…”