Systematic review of the cost-effectiveness of biphasic insulin aspart 30 in type 2 diabetes

Valentine, William J.; Pollock, Richard F; Plun-Favreau, J; White, Jeremy

doi:10.1185/03007991003689381

Cited by 15 publications

(5 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Please note that owing to the lack of adequate sample sizes, we did not perform meta-analysis on other specific regions such as the premotor cortex (PC), the anterior temporal lobe (ATL) and the angular gyrus (AG)], stimulation parameters of the TMS protocols [i.e., methods of brain region localization, stimulation types (further analysis on cTBS but not iTBS (only one study) was conducted considering the inadequate sample sizes), timing, frequencies, and intensities], and experimental designs (i.e., control conditions and group design types) are crucial for the examination of TMS effects on language performance in healthy participants. Effect sizes with an associated 95% confidence intervals (CI) were calculated when at least two studies were available for a particular estimate (see also Valentine et al, 2010 ). The analysis-structure of both the overall and the moderator analyses are summarized in Figure 2 .…”

Section: Methodsmentioning

confidence: 99%

“…one study) was conducted considering the inadequate sample sizes), timing, frequencies, and intensities], and experimental designs (i.e., control conditions and group design types) are crucial for the examination of TMS effects on language performance in healthy participants. Effect sizes with an associated 95% confidence intervals (CI) were calculated when at least two studies were available for a particular estimate (see also Valentine et al, 2010). The analysis-structure of both the overall and the moderator analyses are summarized in Figure 2.…”

Section: Data Analysesmentioning

confidence: 99%

See 1 more Smart Citation

Neuromodulatory effects of transcranial magnetic stimulation on language performance in healthy participants: Systematic review and meta-analysis

Wang

Cheng

et al. 2022

Front. Hum. Neurosci.

View full text Add to dashboard Cite

BackgroundThe causal relationships between neural substrates and human language have been investigated by transcranial magnetic stimulation (TMS). However, the robustness of TMS neuromodulatory effects is still largely unspecified. This study aims to systematically examine the efficacy of TMS on healthy participants’ language performance.MethodsFor this meta-analysis, we searched PubMed, Web of Science, PsycINFO, Scopus, and Google Scholar from database inception until October 15, 2022 for eligible TMS studies on language comprehension and production in healthy adults published in English. The quality of the included studies was assessed with the Cochrane risk of bias tool. Potential publication biases were assessed by funnel plots and the Egger Test. We conducted overall as well as moderator meta-analyses. Effect sizes were estimated using Hedges’g (g) and entered into a three-level random effects model.ResultsThirty-seven studies (797 participants) with 77 effect sizes were included. The three-level random effects model revealed significant overall TMS effects on language performance in healthy participants (RT: g = 0.16, 95% CI: 0.04–0.29; ACC: g = 0.14, 95% CI: 0.04–0.24). Further moderator analyses indicated that (a) for language tasks, TMS induced significant neuromodulatory effects on semantic and phonological tasks, but didn’t show significance for syntactic tasks; (b) for cortical targets, TMS effects were not significant in left frontal, temporal or parietal regions, but were marginally significant in the inferior frontal gyrus in a finer-scale analysis; (c) for stimulation parameters, stimulation sites extracted from previous studies, rTMS, and intensities calibrated to the individual resting motor threshold are more prone to induce robust TMS effects. As for stimulation frequencies and timing, both high and low frequencies, online and offline stimulation elicited significant effects; (d) for experimental designs, studies adopting sham TMS or no TMS as the control condition and within-subject design obtained more significant effects.DiscussionOverall, the results show that TMS may robustly modulate healthy adults’ language performance and scrutinize the brain-and-language relation in a profound fashion. However, due to limited sample size and constraints in the current meta-analysis approach, analyses at a more comprehensive level were not conducted and results need to be confirmed by future studies.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=366481], identifier [CRD42022366481].

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Data Analysesmentioning

confidence: 99%

Neuromodulatory effects of transcranial magnetic stimulation on language performance in healthy participants: Systematic review and meta-analysis

Wang

Cheng

et al. 2022

Front. Hum. Neurosci.

View full text Add to dashboard Cite

show abstract

“…It is recommended that if lifestyle modification and full tolerated doses of one or two oral glucose lowering drugs (OGLDs) fail to achieve or sustain glycemic goals, then insulin therapy should be initiated [ 10 ]. Over the past decade, insulin analogs have gained recognition since they offer numerous advantages over the traditional preparations with regard to blood glucose variability, number of injections needed, patient satisfaction, and life expectancy [ 11 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…For instance, Palmer and colleagues have shown that switching from traditional preparations to biphasic insulin Aspart 30 (BIAsp 30) would result in an additional $ 9000 in terms of life-time direct medical costs [ 15 ]. A number of previous studies have delineated the efficacy, safety, and cost-effectiveness of BIAsp 30 in patients with diabetes [ 14 – 17 ]; yet the cost-effectiveness of such therapy has not been explored in Iran. The aim of the present piggyback study was to investigate the cost-effectiveness of BIAsp 30 using the data from a clinical trial Iranian patients with T2DM.…”

Section: Introductionmentioning

confidence: 99%

Biphasic insulin Aspart 30 vs. NPH plus regular human insulin in type 2 diabetes patients; a cost-effectiveness study

et al. 2016

View full text Add to dashboard Cite

BackgroundThe aim of this study was to compare the efficacy, safety, costs, and cost-effectiveness of biphasic insulin aspart 30 (BIAsp 30) with NPH plus regular human insulin (NPH/Reg) in patients with type 2 diabetes mellitus (T2DM).MethodsIt was a Single-center, parallel-group, randomized, clinical trial (Trial Registration: NCT01889095). One hundred and seventy four T2DM patients with poorly controlled diabetes (HbA1c ≥ 8 % (63.9 mmol/mol)) were randomly assigned to trial arms (BIAsp 30 and NPH/Reg) and were followed up for 48 weeks. BIAsp 30 was started at an initial dose of 0.2–0.6 IU/Kg in two divided doses and was titrated according to the glycemic status of the patient. Similarly, NPH/Reg insulin was initiated at a dose of 0.2–0.6 IU/Kg with a 2:1 ratio and was subsequently titrated. Level of glycemic control, hypoglycemic events, direct and indirect costs, quality adjusted life year (QALY) and incremental cost-effectiveness ratio have been assessed.ResultsHbA1c, Fasting plasma glucose (FPG), and two-hour post-prandial glucose (PPG) were improved in both groups during the study (P < 0.05 for all analyses). Lower frequencies of minor, major, and nocturnal hypoglycemic episodes were observed with BIAsp 30 (P < 0.05). Additionally, BIAsp 30 was associated with less weight gain and also higher QALYs (P < 0.05). Total medical and non-medical costs were significantly lower with BIAsp 30 as compared with NPH/Reg (930.55 ± 81.43 USD vs. 1101.24 ± 165.49 USD, P = 0.004). Moreover, BIAsp 30 showed lower ICER as a dominant alternative.ConclusionsDespite being more expensive, BIAsp 30 offers the same glycemic control as to NPH/Reg dose-dependently and also appears to cause fewer hypoglycemic events and to be more cost-effective in Iranian patients with type 2 diabetes.

show abstract

“…Cost-effectiveness of biphasic insulin aspart 30 compared with glargine has been summarized in a systematic review utilizing the validated CORE diabetes model, which concluded that treatment with biphasic aspart is associated with increased quality-adjusted life expectancy in several countries, resulting in incremental cost-effectiveness ratios of approximately USD 46500 and GBP 6950 per qualityadjusted life year gained in the United Stated and the United Kingdom, respectively [13]. On the other hand, combination of glargine with oral antidiabetic agents was shown to be cost-effective in comparison to monotherapy with premixed insulin in insulin-naïve patients in Canada [14].…”

mentioning

confidence: 99%

Premixed insulin regimens for type 2 diabetes

Karagiannis

Bekiari

2015

Endocrine

View full text Add to dashboard Cite

Type 2 diabetes mellitus is a disease characterized by progressive b-cell failure, and many patients will eventually require insulin therapy to maintain glycemic control [1]. Premixed (biphasic) insulin regimens are an insulin treatment scheme prescribed both in insulin-naive patients and insulin-treated patients who need further treatment intensification [2,3]. Alternative options include basal insulin for initiating insulin therapy and basal-plus or basal-bolus regimens for insulin treatment intensification. There is currently no unanimous guidance regarding the role of premixed insulin regimens as opposed to other types of insulin, both for initiating and for intensifying insulin therapy in type 2 diabetes. The American Diabetes Association and the European Association for the Study of Diabetes suggest initiation therapy with basal insulin and consider premixed regimens only as intensification therapy in selected patients [4]. Conversely, the International Diabetes Federation recommends beginning insulin therapy with either basal insulin once daily or biphasic insulin once or twice daily [5], while the National Institute for Health and Care Excellence in the United Kingdom considers both basal insulin and premixed regimens as secondary options to human NPH insulin for initiating insulin therapy [6].In a meta-analysis by Giugliano et al. published in this issue, overall, there was no difference in HbA 1c lowering between premixed insulin and basal-bolus insulin regimens, including a subgroup analysis comparing variable premixed insulin with variable basal-bolus regimens [7]. How do these data compare to findings from recent individual trials and existing meta-analyses?For insulin-naïve patients, several meta-analyses have explored the efficacy of premixed insulin against basal, basal-plus, or basal-bolus insulin regimens. In a metaanalysis of five randomized controlled trials (RCTs) in insulin-naïve patients, biphasic insulin was associated with greater reductions in HbA 1c compared to basal insulin (weighted mean difference -0.45 %; 95 % confidence interval -0.70 to -0.19) [8]. Likewise, a more recent meta-analysis demonstrated that treatment with biphasic insulin aspart 30 (aspart/aspart protamine 30/70) once or twice daily resulted in better glycemic control in comparison with insulin glargine once daily (-0.21 %; -0.35 to -0.08) [9]. Similarly, the recently published GALAPA-GOS study demonstrated that in insulin-naive patients, premixed insulin once or twice daily reduced HbA 1c by a further 0.16 % (confidence interval 0.04 to 0.27) compared with insulin glargine with or without insulin glulisine [10]. Finally, in a subgroup analysis in insulin-naïve patients, premixed regimen had no difference with basal-bolus regimens (-0.15 %; -0.52 to 0.22) [11].For patients already on basal insulin, results from the LanScape study suggested that basal-plus regimens (glargine plus insulin glulisine once daily) are non-inferior to premixed insulin (biphasic insulin aspart 30 twice daily) in reducing HbA 1c [12]. However...

show abstract

Systematic review of the cost-effectiveness of biphasic insulin aspart 30 in type 2 diabetes

Cited by 15 publications

References 42 publications

Neuromodulatory effects of transcranial magnetic stimulation on language performance in healthy participants: Systematic review and meta-analysis

Neuromodulatory effects of transcranial magnetic stimulation on language performance in healthy participants: Systematic review and meta-analysis

Biphasic insulin Aspart 30 vs. NPH plus regular human insulin in type 2 diabetes patients; a cost-effectiveness study

Premixed insulin regimens for type 2 diabetes

Contact Info

Product

Resources

About