Therapy conversion to insulin detemir among patients with type 2 diabetes treated with oral agents: A modeling study of cost-effectiveness in the United States

Abstract

The aim of this study was to gain a preliminary indication of the long-term clinical and economic implications of converting treatment for patients with type 2 diabetes to insulin detemir+/-oral hypoglycemic agents (OHAs) in a routine clinical practice setting in the United States. With the use of outcome data and patient characteristics reported from an ongoing prospective observational trial, a validated computer simulation model of diabetes was used to project the clinical and cost outcomes associated with therapy conversion to insulin detemir over a 35-y period from (1) OHA only, (2) neutral protamine Hagedorn insulin (NPH)+/-OHA, and (3) insulin glargine+/-OHA. Cost-effectiveness was assessed from a third-party healthcare payer perspective for the year 2005. Costs and clinical outcomes were discounted at a rate of 3%. Treatment with insulin detemir+/-OHA was associated with increases in quality-adjusted life expectancy of 0.309, 0.350, and 0.333 quality-adjusted life-years (QALYs) versus treatment with OHA alone, NPH+/-OHA, and insulin glargine+/-OHA, respectively. Increases in pharmacy costs were partially offset by reduced complications, rticularly renal complications and neuropathy. Projected incremental cost-effectiveness ratios were well within the range considered to represent good value in the United States, at $7412, $6269, and $3951 per QALY gained for treatment with Idet+/-OHA versus OHA alone, NPH+/-OHA, and Iglarg+/-OHA, respectively. On the basis of preliminary evidence of short-term improvements in glycemic control and reduced hypoglycemia, therapy conversion to insulin detemir+/-OHA from OHA alone, NPH+/-OHA, or insulin glargine+/-OHA was projected to increase quality-adjusted life expectancy and to represent a cost-effective treatment option in the United States.

Cost-effectiveness of insulin detemir compared with NPH insulin in people with type 2 diabetes in Denmark, Finland, Norway, and Sweden

“…The results suggest that insulin detemir can be considered a cost-effective treatment alternative to NPH insulin over a one year period in all four countries analysed. These findings are consistent with long-term modelling studies that have compared the economic benefit of insulin analogues and NPH insulin in the treatment of T2DM [44][45][46] .…”

Cost-Effectiveness of Switching Patients with Type 2 Diabetes from Insulin Glargine to Insulin Detemir in Chinese Setting: A Health Economic Model Based on the PREDICTIVE Study

“…They have been proved to more closely reflect physiological basal insulin and are associated with a significantly less risk of hypoglycemia and weight gain [6,7]. Two pharmacoeconomic studies conducted in Germany [8] and the United States [9] evaluated the cost-effectiveness of detemir based on the clinical results of the German PREDICTIVE study. Moreover, other researches from the United Kingdom [10], Canada [11], and Europe [12] also systematically evaluated the long-term health benefits of detemir caused by the reduction in the hemoglobin A 1c (Hb A 1c ) level.…”

Economic models in type 2 diabetes

“…Over the years, the CORE model has been widely adapted to many countries with minor modifications. It has been used in a number of published economic evaluations[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] , and has been used by manufacturers and HTA agencies in the UK, Canada and the Netherlands.The UKPDS Outcomes Model 10 was developed in 2004 based on the single UKPDS study and has been used over the years with no major structural changes 50 . The model is a probabilistic discrete time illness-death simulation model and uses Monte Carlo methods to predict the occurrence of events at the individual patient level.…”