Patients with type 2 diabetes in Denmark were willing to pay for the health benefits associated with improved diabetes treatment, the most important of these being weight loss or avoidance of weight gain, and reduction of HbA(1c) and of hypoglycaemic events.

Objective: To assess the cost-effectiveness of insulin detemir compared with Neutral Protamine Hagedorn (NPH) insulin when initiating insulin treatment in people with type 2 diabetes mellitus (T2DM) in Denmark, Finland, Norway and Sweden.Methods: Efficacy and safety data were derived from a 20-week multicentre randomised controlled head-to-head clinical trial comparing insulin detemir and NPH insulin in insulin naïve people with T2DM, and short-term (one-year) cost effectiveness analyses were performed. As no significant differences in HbA 1c were observed between the two treatment arms, the model was based on significant differences in favour of insulin detemir in frequency of hypoglycaemia (Rate-Ratio = 0.52; CI: 0.44 -0.61) and weight gain (∆ 0.9 kg). Model outcomes were measured in Quality Adjusted Life Years (QALYs) using published utility estimates. Acquisition costs for insulin and direct healthcare costs associated with non-severe hypoglycaemic events were obtained from National Health Service public sources. One-way and probabilistic sensitivity analyses were performed. Conclusions:The lower risk of non-severe hypoglycaemia and less weight gain associated with using insulin detemir compared with NPH insulin when initiating insulin treatment in insulin naïve patients with type 2 diabetes provide economic benefits in the short-term. Based on cost/QALY threshold values, this represents good value for money in the Nordic countries. Using a short-term modelling approach may be conservative as reduced frequency of hypoglycaemia and less weight gain may also have positive long term health-related implications.3