Two-year glycaemic control and healthcare expenditures following initiation of insulin glargine versus neutral protamine Hagedorn insulin in type 2 diabetes

Rhoads, George G.; Dain, Marie-Paule; Zhang, Q.; Kennedy, Laurence

doi:10.1111/j.1463-1326.2011.01394.x

Cited by 10 publications

(7 citation statements)

References 14 publications

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“…Once-daily insulin glargine has been shown to provide at least as effective glycaemic control as NPH insulin, and to be cost effective in a range of countries and settings. [33][34][35][36][37][38][39] Basal insulin analogues have been shown to have several advantages compared with NPH insulin, including less pharmacological variability, a lower risk of hypoglycaemia and a greater impact on quality of life. 18 20 21 40 The rates of hypoglycaemia-related events were, however, similar for insulin glargine and NPH insulin in this study.…”

Section: Discussionmentioning

confidence: 99%

Real-world outcomes of US employees with type 2 diabetes mellitus treated with insulin glargine or neutral protamine Hagedorn insulin: a comparative retrospective database study

et al. 2013

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ObjectivesTo compare real-world outcomes of initiating insulin glargine (GLA) versus neutral protamine Hagedorn (NPH) insulin among employees with type 2 diabetes mellitus (T2DM) who had both employer-sponsored health insurance and short-tem-disability coverages.DesignRetrospective cohort study.SettingMarketScan Commercial Claims and Encounters/Health and Productivity Management Databases 2003–2009.ParticipantsAdult employees with T2DM who were previously treated with oral antidiabetic drugs and/or glucagon-like-peptide 1 receptor agonists and initiated GLA or NPH were included if they were continuously enrolled in healthcare and short-term-disability coverages for 3 months before (baseline) and 1 year after (follow-up) initiation. Treatment selection bias was addressed by 2:1 propensity score matching. Sensitivity analyses were conducted using different matching ratios.Primary and secondary outcome measuresOutcomes during 1-year follow-up were measured and compared: insulin treatment persistence and adherence; hypoglycaemia rates and daily average consumption of insulin; total and diabetes-specific healthcare resource utilisation and costs and loss in productivity, as measured by short-term disability, and the associated costs.ResultsA total of 534 patients were matched and analysed (GLA: 356; NPH 178) with no significant differences in baseline characteristics. GLA patients were more persistent and adherent (both p<0.05), had lower rates of hospitalisation (23% vs 31.4%; p=0.036) and endocrinologist visits (19.1% vs 26.9%; p=0.038), similar hypoglycaemia rates (both 4.4%; p=1.0), higher diabetes drug costs ($2031 vs $1522; p<0.001), but similar total healthcare costs ($14 550 vs $16 093; p=0.448) and total diabetes-related healthcare costs ($4686 vs $5604; p=0.416). Short-term disability days and costs were numerically lower in the GLA cohort (16.0 vs 24.5 days; p=0.086 and $2824 vs $4363; p=0.081, respectively). Sensitivity analyses yielded similar findings.ConclusionsInsulin GLA results in better persistence and adherence, compared with NPH insulin, with no overall cost disadvantages. Better persistence and adherence may lead to long-term health benefits for employees with T2DM.

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Section: Discussionmentioning

confidence: 99%

Real-world outcomes of US employees with type 2 diabetes mellitus treated with insulin glargine or neutral protamine Hagedorn insulin: a comparative retrospective database study

et al. 2013

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“…Many practitioners would use a sulfonylurea as a second drug. Although such agents carry a risk of hypoglycemia, they are available in inexpensive generic forms, there is wide experience with their use, and they may be more cost-effective than other, newer drugs (59,60). Alternatives with less of a risk of hypoglycemia include GLP-1 analogs, DPP-4 inhibitors, thiazolidinediones, SGLT-2 inhibitors, α-glucosidase inhibitors, colesevelam, bromocriptine, and glinides.…”

Section: How Medical Practice Should Changementioning

confidence: 99%

We Can Change the Natural History of Type 2 Diabetes

et al. 2014

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As diabetes develops, we currently waste the first ∼10 years of the natural history. If we found prediabetes and early diabetes when they first presented and treated them more effectively, we could prevent or delay the progression of hyperglycemia and the development of complications. Evidence for this comes from trials where lifestyle change and/or glucose-lowering medications decreased progression from prediabetes to diabetes. After withdrawal of these interventions, there was no “catch-up”—cumulative development of diabetes in the previously treated groups remained less than in control subjects. Moreover, achieving normal glucose levels even transiently during the trials was associated with a substantial reduction in subsequent development of diabetes. These findings indicate that we can change the natural history through routine screening to find prediabetes and early diabetes, combined with management aimed to keep glucose levels as close to normal as possible, without hypoglycemia. We should also test the hypothesis with a randomized controlled trial.

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“…Of the reviewed studies nine were considered relevant (Tables 2, 3) [14, 21–28]. All studies were industry-sponsored.…”

Section: Resultsmentioning

confidence: 99%

“…All studies were industry-sponsored. Details of the included studies including number of people, treatment setting, study year, study design and follow-up period, mean age, and primary objective, are reported in Table 4 [14, 21–28]. …”

Section: Resultsmentioning

confidence: 99%

Evaluation of Insulin Use and Value for Money in Type 2 Diabetes in the United Kingdom

Gordon

Evans

McEwan³

et al. 2013

Diabetes Ther

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IntroductionIt is unclear as to whether human or long-acting analog insulins represent the most efficient use of health and non-healthcare resources in the management of type 2 diabetes mellitus (T2DM). The aim of this study was to evaluate the value for money relationship associated with the use of these insulins in the UK setting.MethodsA literature search was performed for studies reporting expenditure associated with the use of human and analog insulins. Data from this review informed a budget impact assessment model. Costs were converted to a common currency and results are reported in 2011 British pounds sterling (GBP) values.ResultsAnnual diabetes-related medication expenditure and patients total expenditure associated with the management of T2DM were estimated to be £397 million and £3,901 million, respectively. Substitution of human insulin for analog insulins was associated with a drug acquisition cost saving of between £5 million and £23 million each year. Overall, though, total expenditure increased significantly with increased use of human insulin by £34 million to £136 million each year depending on the degree of substitution.ConclusionsOn the face of it, analog insulins are more expensive, prompting questions about potential cost savings to health services in the UK from direct substitution to the less expensive human preparation. The current analysis illustrates that the increased use of human insulin and decreased use of analog insulin would, however, increase the overall net societal cost of managing insulin-treated patients with T2DM. Governments and decision makers should consider that total healthcare expenditure would not necessarily fall when decisions are based solely on the use of cheaper products.

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Two-year glycaemic control and healthcare expenditures following initiation of insulin glargine versus neutral protamine Hagedorn insulin in type 2 diabetes

Abstract: Glargine therapy may be an effective long-term option for improving glycaemic control, with lower rates of hypoglycaemia and healthcare costs in patients with T2D.

Cited by 10 publications

References 14 publications

Real-world outcomes of US employees with type 2 diabetes mellitus treated with insulin glargine or neutral protamine Hagedorn insulin: a comparative retrospective database study

Real-world outcomes of US employees with type 2 diabetes mellitus treated with insulin glargine or neutral protamine Hagedorn insulin: a comparative retrospective database study

We Can Change the Natural History of Type 2 Diabetes

Evaluation of Insulin Use and Value for Money in Type 2 Diabetes in the United Kingdom

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