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An analysis of the cost-effectiveness of starting insulin detemir in insulin-naive people with type 2 diabetes

Lookup NU author(s): Emeritus Professor Philip Home


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Aims:There is limited evidence with respect to the cost-effectiveness of starting insulin in people with diabetes outside the 'western' world. The aim of this study was to assess the cost-effectiveness of starting basal insulin treatment with insulin detemir in people with type 2 diabetes (T2D) inadequately controlled on oral glucose-lowering drugs (OGLDs) in Mexico, South Korea, India, Indonesia, and Algeria.Methods:The IMS CORE Diabetes Model was used to project clinical and cost outcomes over a 30-year time horizon. Clinical outcomes, baseline characteristics and health state utility data were taken from the A(1)chieve study. A 1-year analysis was also conducted based on treatment costs and quality-of-life data. Incremental cost-effectiveness ratios (ICERs) were expressed as a fraction of GDP per capita, and WHO-CHOICE recommendations (ICER<3.0) used to define cost-effectiveness.Results:Starting insulin detemir was associated with a projected increase in life expectancy (>= 1 year) and was considered cost-effective in all of the studied populations with ICERs of -0.02 (Mexico), 0.00 (South Korea), 0.48 (India), 0.12 (Indonesia), and 0.88 (Algeria) GDP/quality-adjusted life-year. Cost-effectiveness was maintained after conducting sensitivity analyses in the 30-year and 1-year analyses. A projected increase in treatment costs was partially offset by a reduction in complications. The difference in overall costs between insulin detemir and OGLDs alone was USD518, 1431, 3510, 15, and 5219, respectively.Conclusion:Changes in clinical outcomes associated with starting insulin detemir in insulin-naive individuals with T2D resulted in health gains that made the intervention cost-effective in five countries with distinct healthcare resources.

Publication metadata

Author(s): Home P, Baik SH, Galvez GG, Malek R, Nikolajsen A

Publication type: Article

Publication status: Published

Journal: Journal of Medical Economics

Year: 2015

Volume: 18

Issue: 3

Pages: 230-240

Print publication date: 01/03/2015

Online publication date: 21/11/2014

Acceptance date: 05/11/2014

ISSN (print): 1369-6998

ISSN (electronic): 1941-837X

Publisher: Informa Healthcare


DOI: 10.3111/13696998.2014.985788


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