Is the use of insulin analogues cost-effective?

Abstract

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.

Managing diabetes-related costs and quality of life issues: Value of insulin analogs and pens for inpatient use

“…Cost reductions were reported to range from $1580 to $5580 per patient as a result of rigorous glycemic programs targeting hyperglycemia prevention [5,35]. New developments in insulin technology and insulin delivery, such as insulin analogs and pens, have been shown to provide similar glycemic control, with less nocturnal hypoglycemia and better adherence [36], and may be cost-effective compared with NPH insulin and vial/syringe administration, respectively [37][38][39][40][41][42].…”

“…Analogs are available as rapid-and long-acting formulations; are typically administered subcutaneously; and are associated with comparable glycemic control, reduced nocturnal hypoglycemia, and less inter-and intrapatient variability in glycemic control; and may be more cost-effective compared with human insulins [36][37][38][39][40][41][42][43]. Insulin analogs have altered rates of hexamer formation and dissociation compared with human insulins, which results in different rates of movement of free insulin into the circulation [44] and, therefore, pharmacokinetic and pharmacodynamic properties that more closely resemble physiological prandial and basal insulin release.…”

“…In fact, the most recent AACE/ACE algorithm for glycemic control recommends against the use of human insulins due to their less predictable pharmacologic profile and increased risk of hypoglycemia [49]. In addition, analogs have the potential to reduce costs in hospitalized patients, as evidenced by data that demonstrate their ability to reduce the incidence of hypoglycemia and to minimize glucose fluctuations compared with traditional insulins, such as regular and NPH insulin [37,38]. Rapid-acting analogs mimic normal insulin physiology more closely than regular or NPH insulin and have been associated with less frequent and less severe episodes of hypoglycemia [50,51].…”

“…These studies have found insulin analogs to be a cost-effective alternative to human insulins and an appropriate investment of healthcare dollars [37,38,[59][60][61][62]. However, not all studies have reported that the use of insulin analogs among outpatients is cost-effective in all patients [41,42].…”

“…Factors that impact the likelihood of hypoglycemia include the insulin's onset, peak, and duration of action as well as the predictability of these parameters. Therefore, the reduced frequency and severity of hypoglycemia with the use of analogs may prevent the complications of hypoglycemia, reducing hospital length of stay and costs incurred during hospitalization [38].…”