Modelling Cost Effectiveness of Insulin Glargine for the Treatment of Type 1 and 2 Diabetes in Canada

Grima, Daniel; Thompson, Melissa; Sauriol, Luc

doi:10.2165/00019053-200725030-00007

Cited by 40 publications

(71 citation statements)

References 48 publications

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“…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] .…”

supporting

confidence: 88%

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

Ridderstråle

Jensen

Gjesing

et al. 2013

Journal of Medical Economics

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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

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supporting

confidence: 88%

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

Ridderstråle

Jensen

Gjesing

et al. 2013

Journal of Medical Economics

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“…35,59,60 For example, the incremental cost per quality-adjusted life-year estimated by Grima and colleagues 59 for insulin glargine in patients with type 1 diabetes increased from Can$20 799 to Can$87 132 when effect sizes of hemoglobin A 1c were decreased from 0.40% to 0.20%. 59 When fear of hypoglycemia was included in an evaluation by the National Institute of Clinical Excellence in London, England, the incremental cost per quality-adjusted lifeyear for insulin glargine compared with neutral protamine Hagedorn insulin was reduced from £32 000 to £3500 for type 1 diabetes and from £120 000 to £32 500 for type 2 diabetes. 60 The Center for Outcomes Research Diabetes Model 6 accommodates fear of hypoglycemia by applying a chronic decrement to health-related quality-of-life scores in the conventional-insulin arm only.…”

Section: Limitationsmentioning

confidence: 99%

Cost-effectiveness of insulin analogues for diabetes mellitus

Cameron¹,

Bennett²

2009

Canadian Medical Association Journal

100

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Insulin agents available for the treatment of diabetes mellitus include conventional insulins and insulin analogues. Insulin analogues were developed to mimic more closely the separate bolus and basal components of insulin secretion.1 Rapid-acting (bolus or mealtime) and longacting (basal or background) analogue formulations are available. This new class of drugs has been promoted as providing more flexible treatment schedules and a reduced risk of hypoglycemia relative to conventional insulins. 1The cost of insulin analogues exceeds that of conventional insulins.2,3 More than US$7.3 billion was spent globally on the purchase of insulin products in 2005 -an increase of 19% over the previous year.4 It has been suggested that the increased expenditure was due to both the increasing prevalence of diabetes and the increased use of insulin analogues. 5 We performed an analysis of the cost-effectiveness of insulin analogues compared with conventional insulins in the management of type 1 or type 2 diabetes in adults. MethodsThe economic model We used the Center for Outcomes Research Diabetes Model 6 to calculate the cost-effectiveness estimates. This model, described in detail by Palmer and colleagues, 6 has been validated against published clinical and epidemiologic studies (Figure 1). 7 Using data derived from the published literature, the model uses mathematical equations to determine the diabetes-related complications that would occur throughout a patient's life span. 6 The equations take into consideration risk factors such as age and hemoglobin A 1c levels, as well as patient characteristics, type of diabetes and history of diabetesrelated complications. 6 For type 1 and type 2 diabetes, correlation analyses produced R 2 estimates of 0.9778 and 0.8861, which demonstrate that simulations in the Center for Outcomes Research Diabetes Model 6 provide a reasonably accurate representation of patient outcomes in real-life settings. 7 We derived the clinical effects of therapy (hemoglobin A 1c , mild to moderate hypoglycemia and severe hypoglycemia), required as inputs for the model, from meta-analyses of randomized controlled trials (Table 1). [8][9][10] We compared rapidacting insulin analogues (insulin aspart and insulin lispro) with regular human insulin. We compared long-acting analogues (insulin glargine and insulin detemir) with neutral protamine Hagedorn insulin. For treatment comparisons, we

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“…(16) One CUA found that iDet was dominant (less costly and more effective) over iGlarg, (44) while another found that iGlarg was the dominant option when compared to iDet. (16) The results of our economic analysis are in line with the findings from some of these previously published cost-utility analyses, which found that iDet was cost effective compared to iNPH (ICERs: £2,500, £3,443, £9,526, £12,989 and £19,285 per QALY gained), (18;20;42-44) iGlarg was cost effective compared to iNPH (ICERs: £3,496 -£4,978, £3,189 -£9-767 and £10,903 per QALY gained), (45)(46)(47) and one study finding that iDet was dominant (less costly and more effective) over iGlarg. (44) However, this last analysis and ours conflict with that of Cameron and colleagues, (16) which concluded that iGlarg dominated iDet.…”

Section: Discussionmentioning

confidence: 77%

“…(16) Three CUAs found that iGlarg was cost effective compared to iNPH, (45)(46)(47) another found that iGlarg was dominant compared to iNPH,(48) while another found that iGlarg was not cost effective compared to iNPH. (16) One CUA found that iDet was dominant (less costly and more effective) over iGlarg, (44) while another found that iGlarg was the dominant option when compared to iDet.…”

Section: Discussionmentioning

confidence: 99%

Basal Insulin Regimens for Adults with Type 1 Diabetes Mellitus: A Cost-Utility Analysis

et al. 2017

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ObjectivesTo assess the cost effectiveness of basal insulin regimens for adults with Type 1 diabetes (T1D) in England. MethodsCost-utility analysis (CUA) was undertaken in accordance with NICE reference case. UK NHS and personal and social services (PSS) perspective was used and 3.5% discount rate applied for both costs and outcomes. Relative effectiveness estimates were based on a systematic review of published trials and a Bayesian network meta-analysis (NMA). The IMS CORE Diabetes Model (CDM) was used, where net monetary benefit (NMB) was calculated using a threshold of £20,000 per quality-adjusted life-year (QALY) gained. Wide range of sensitivity analyses was undertaken. ResultsInsulin detemir (twice-daily) [iDet (bid)] had the highest mean QALY gain (11.09 QALYs) and NMB (£181,456) per patient over the model time horizon. Compared to the lowest cost strategy (insulin NPH once daily [iNPH (od)]; it had an incremental cost-effectiveness ratio (ICER) of £7,844 per QALY-gained. Insulin glargine (od) [iGlarg (od)] and iDet (od) were ranked as second and third, with NMB of £180,893 and £180,423, respectively. iDet (bid)] remained the most cost-effective treatment throughout the sensitivity analyses performed except when high doses were assumed (>30% increment compared to other regimens); where in this scenario analysis iGlarg (od) ranked first. ConclusionsiDet (bid) is the most cost-effective regimen; providing the highest QALY gain and NMB. iGlarg (od) and iDet (od) are possible options for those for whom the twice daily regimen of insulin determir is not acceptable or does not achieve required glycaemic control.

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Modelling Cost Effectiveness of Insulin Glargine for the Treatment of Type 1 and 2 Diabetes in Canada

Abstract: The cost-effectiveness ratios for insulin glargine use for type 1 and 2 diabetes provide evidence for its adoption from a Canadian healthcare payer perspective.

Cited by 40 publications

References 48 publications

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

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

Cost-effectiveness of insulin analogues for diabetes mellitus

Basal Insulin Regimens for Adults with Type 1 Diabetes Mellitus: A Cost-Utility Analysis

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