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Cost-effectiveness of insulin analogues for diabetes mellitus

Chris Cameron and Heather Bennett are with the Canadian Agency for Drugs and Technologies in Health, Ottawa, Ont.

Correspondence to: Chris Cameron, Canadian Optimal Medication Prescribing and Utilization Service, Canadian Agency for Drugs and Technologies in Health, 600–865 Carling Ave., Ottawa ON K1S 5S8; fax 613 226-5392; chrisc{at}cadth.ca

Background: Insulin analogues may be associated with fewer episodes of hypoglycemia than conventional insulins. However, they are costly alternatives. We compared the cost-effectiveness of insulin analogues and conventional insulins used to treat type 1 and type 2 diabetes mellitus in adults.

Methods: We conducted a cost-effectiveness evaluation of insulin analogues versus conventional insulins using the Center for Outcomes Research Diabetes Model. We compared rapid-acting analogues (insulin aspart and insulin lispro) with regular human insulin, and long-acting analogues (insulin glargine and insulin detemir) with neutral protamine Hagedorn insulin. We derived clinical information for the comparisons from meta-analyses of randomized controlled trials. We obtained cost and utility estimates from published sources. We performed sensitivity analyses to test the robustness of our results.

Results: For type 1 diabetes, insulin aspart was more effective and less costly than regular human insulin. Insulin lispro was associated with an incremental cost of Can$28 996 per quality-adjusted life-year. The incremental cost per quality-adjusted life-year was Can$87 932 for insulin glargine and Can$387 729 for insulin detemir, compared with neutral protamine Hagedorn insulin. For type 2 diabetes, insulin aspart was associated with an incremental cost of Can$22 488 per quality-adjusted life-year compared with regular human insulin. For insulin lispro, the incremental cost was Can$130 865. Compared with neutral protamine Hagedorn insulin, insulin detemir was less effective and more costly. Insulin glargine was associated with an incremental cost of Can$642 994 per quality-adjusted life-year. The model was sensitive to changes in the effect size of hemoglobin A_1c and to decrements applied to utility scores when fear of hypoglycemia was included as a factor.

Interpretation: The cost-effectiveness of insulin analogues depends on the type of insulin analogue and whether the patient receiving the treatment has type 1 or type 2 diabetes. With the exception of rapid-acting insulin analogues in type 1 diabetes, routine use of insulin analogues, especially long-acting analogues in type 2 diabetes, is unlikely to represent an efficient use of finite health care resources.

This article has been cited by other articles:

				S. R. Singh BScPhm MSc, F. Ahmad MSc, A. Lal MD PhD, C. Yu MD MSc, Z. Bai MD MSc, and H. Bennett BPharm PhD Efficacy and safety of insulin analogues for the management of diabetes mellitus: a meta-analysis Can. Med. Assoc. J., February 17, 2009; 180(4): 385 - 397. [Abstract] [Full Text] [PDF]

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