Article
Cost-effectiveness of insulin glargine versus NPH insulin in type 1 diabetes using basal bolus treatment in a German setting
Search Medline for
Authors
-
Peter K. Schädlich
- IGES Institut GmbH, Berlin, Germany
-
Franz-Werner Dippel
- Sanofi-Aventis Deutschland GmbH, Berlin, Germany
-
Katharina C. Koltermann
- IGES Institut GmbH, Berlin, Germany
-
Martin Pfohl
- Evangelisches Bethesda-Johanniter-Klinikum Duisburg GmbH, Duisburg, Germany
| Published: | November 22, 2010 |
|---|---|
| Published with erratum: | December 14, 2010 |
Outline
Text
Introduction: Basal insulin analogues are well established in the treatment of type 1 diabetes. Yet only little is known about their economic impact. The aim of this study therefore was to compare, from the perspective of the Statutory Health Insurance (SHI), the cost effectiveness of the long-acting insulin analogue glargine (GLA) with intermediate-acting neutral protamine Hagedorn insulin (NPH), considering the interaction between glycaemic control (HbA1c) and rate of hypoglycaemia.
Methods: The validated Cardiff Research Consortium (CRC) discrete event simulation model was adapted to German conditions to project clinical and cost outcomes over 40 years. This model is mainly based on published evidence from DCCT trial, the THIN database, and a meta-regression analysis of combined HbA1c and hypoglycaemia outcomes. Disutilities were taken from the model. Resources were valued with German official prices in 2010 euros. Patient characteristics and risk factors were partially extracted from German sources in a sensitivity analysis.
Results: In the base-case analysis, GLA was dominant as it increased life expectancy by 0.196 years and improved quality-adjusted life-years (QALYs) by 0.396 units when at the same time leading to savings of € 5,246, each per patient after 40 years, compared to NPH. These results were robust in the sensitivity analyses. Monte Carlo simulation confirmed dominance of GLA in 70% (life-years gained) and 80% (QALYs gained) of the iterations. The price of GLA had the highest impact on the savings. Only in extreme scenarios, incremental cost-effectiveness ratios increased up to € 9,576 per QALY gained, which is still considered good value for money.
Discussion: The underlying CRC model, a derivative of the CORE model, represents a high standard. Nevertheless, demographics and risk factors could only partially be extracted from German sources. Compared to NPH, GLA is cost effective or even cost saving among type 1 diabetics with basal bolus therapy from the perspective of SHI. In conclusion, glargine represents an attractive clinical and economic intervention in Germany even though actual changes in pricing restrictions (i.e. 16% brand discount to SHI for insulin analogues but not for NPH) were not yet considered.
Supported by Sanofi-Aventis Deutschland GmbH, Berlin.
