Artikel
Resource utilization and treatment costs in type 2 diabetes on intensified insulin therapy with insulin glargine compared to insulin detemir under real world conditions in Germany
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Autoren
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R. A. Bierwirth
- Diabetes Centre, Essen, Germany
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J. Knollmeyer
- Sanofi-Aventis Germany, Frankfurt, Germany
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T. Kohlmann
- Institute for Community Medicine, University Greifswald, Germany
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R. Holle
- LIVE-COM study group, Helmholtz Centre, Neuherberg, Germany
| Veröffentlicht: | 5. November 2009 |
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Gliederung
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Background and aim: To compare resource utilization and costs of type 2 diabetic (T2D) patients either treated with insulin glargine (GLA) or insulin detemir (DET) in a basal-bolus regimen.
Material and method: LIVE-COM* was a non interventional, cross sectional, retrospective study in 138 primary care centers in Germany (representative sample) performed from April–Sep 2008. 1731 T2D patients with statutory health insurance (SHI) status were enrolled when either treated with GLA (n=1150) or DET (n=581) in a basal-bolus therapy for at least 6 months prior to documentation. Total direct diabetes treatment costs (DTC) derived from antidiabetic medications (insulins, oral drugs), blood glucose self-monitoring (test strips, lancets), needles and hypokit use for severe hypoglycaemia were assessed retrospectively over 6 months.
Results: Patient characteristics for GLA (53% male) and DET (49% male) were (mean) age: 66/65 years, BMI: 31.3/32.7 kg/m², HbA1c: 7.50/7.69%, fasting blood glucose: 140/148 mg/dl, onset of diabetes (>10 yrs: 60/59%), start of insulin therapy (>5 yrs: 62/64%), number of diabetic complications and risk factors (3.0/2.9). Resource use: GLA patients had on average fewer basal insulin injections per day (1.1 vs. 1.3) and required significantly less test strips for blood glucose self-measurements (3.2 vs. 3.6). Mean daily total insulin dose (basal/bolus) was significantly lower in GLA (27.7/40.3 U) compared to DET (32.1/47.1 U). Reported hypoglycemic events, hospitalization rates and frequency of physician contacts did not differ between groups. Adjusted mean DTC per patient and 6 months were 932 € (GLA) vs. 1061 € (DET); p<0.001. Adjusted mean single costs (GLA vs. DET): basal insulin 223 vs. 246 € (p<0.001), bolus insulin 241 vs. 289 € (p<0.001), oral drugs 37 vs. 36 € (ns), test strips 347 vs. 393 € (p<0.001), needles 68 vs. 80 € (p<0.001), lancets 14 vs. 16 € (ns).
Conclusions: Insulin glargine based basal-bolus regimens resulted in annual cost savings of 256 € per patient compared to DET from the SHI perspective in Germany. Under routine care conditions GLA patients showed better glycemic control.
