Lebensqualität und Behandlungszufriedenheit unter Therapie mit langwirksamen Analoginsulinen

Hagenmeyer, Ernst-Günther; Schädlich, Peter K.; Köster, A. D.; Dippel, FW; Häussler, Bertram

doi:10.1055/s-0029-1208087

Cited by 7 publications

(5 citation statements)

References 12 publications

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“…Quality of life is reduced by diabetes-related long-term macro- and microvascular complications such as coronary heart disease comprising angina pectoris, myocardial infarction, congestive heart failure, and nephropathy as well as retinopathy [36]. Different approaches were used in the included studies as shown in Table 3.…”

Section: Resultsmentioning

confidence: 99%

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

Hagenmeyer¹,

Koltermann²,

Dippel

et al. 2011

Cost Eff Resour Alloc

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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.

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Section: Resultsmentioning

confidence: 99%

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

Hagenmeyer¹,

Koltermann²,

Dippel

et al. 2011

Cost Eff Resour Alloc

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“…Insulin glargine [25, 26] (Lantus) (Figure 2) is the first long-acting insulin analogue having amino acid modifications in both chains. In the A-chain, the asparagine at position 21 is substituted by glycine and the B-chain is elongated at the C-terminus by addition of two arginine residues.…”

Section: Long-acting Basal Insulin Analoguesmentioning

confidence: 99%

“…Insulin detemir [25, 27] (Levemir) (Figure 2) is characterized by acylation of myristic acid to the lysine residue at position 29 in the B-chain and deletion of the last threonine (position 30) in the B-chain. Its protracted action is achieved through delayed resorption caused by the increased self-association and reversible albumin binding at the injection site as well as because albumin binding causes buffering of insulin concentration.…”

Section: Long-acting Basal Insulin Analoguesmentioning

confidence: 99%

Therapeutics of Diabetes Mellitus: Focus on Insulin Analogues and Insulin Pumps

Valla

2010

Experimental Diabetes Research

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Aim. Inadequately controlled diabetes accounts for chronic complications and increases mortality. Its therapeutic management aims in normal HbA1C, prandial and postprandial glucose levels. This review discusses diabetes management focusing on the latest insulin analogues, alternative insulin delivery systems and the artificial pancreas. Results. Intensive insulin therapy with multiple daily injections (MDI) allows better imitation of the physiological rhythm of insulin secretion. Longer-acting, basal insulin analogues provide concomitant improvements in safety, efficacy and variability of glycaemic control, followed by low risks of hypoglycaemia. Continuous subcutaneous insulin infusion (CSII) provides long-term glycaemic control especially in type 1 diabetic patients, while reducing hypoglycaemic episodes and glycaemic variability. Continuous subcutaneous glucose monitoring (CGM) systems provide information on postprandial glucose excursions and nocturnal hypo- and/or hyperglycemias. This information enhances treatment options, provides a useful tool for self-monitoring and allows safer achievement of treatment targets. In the absence of a cure-like pancreas or islets transplants, artificial “closed-loop” systems mimicking the pancreatic activity have been also developed. Conclusions. Individualized treatment plans for insulin initiation and administration mode are critical in achieving target glycaemic levels. Progress in these fields is expected to facilitate and improve the quality of life of diabetic patients.

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“…Die diskutierten Studien lassen schlussfolgern, dass einfache Therapieschemata bezüglich einer guten Stoffwechselkontrolle effektiv sind und positive Effekte auf die Lebensqualität aufweisen. Insbesondere im Hinblick auf eine Reduktion des Hypoglykämie-risikos sowie einer Verbesserung der Behandlungszufriedenheit und der Lebensqualität älterer Menschen wäre ein einfaches Therapieschema auch im hohen Lebensalter wünschenswert[20][21][22]25]. Bei der hier vorliegenden Untersuchung handelt es sich um eine Erhebung von Primärdaten in einem schwer zugänglichen Bereich des Gesundheitswesens.…”

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Aktuelle Versorgungssituation und Ressourcenbedarf bei insulinpflichtigen Typ-2-Diabetikern in ambulanter und stationärer Pflege: Ergebnisse der LIVE-GERI Studie

Zeyfang¹,

Dippel²,

Bahrmann³

et al. 2010

Diabetologie und Stoffwechsel

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Lebensqualität und Behandlungszufriedenheit unter Therapie mit langwirksamen Analoginsulinen

Cited by 7 publications

References 12 publications

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

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

Therapeutics of Diabetes Mellitus: Focus on Insulin Analogues and Insulin Pumps

Aktuelle Versorgungssituation und Ressourcenbedarf bei insulinpflichtigen Typ-2-Diabetikern in ambulanter und stationärer Pflege: Ergebnisse der LIVE-GERI Studie

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