Análisis de costo-efectividad del uso de Detemir en pacientes con diabetes tipo 2 en riesgo de presentar eventos cardiovasculares y muerte en Colombia

Abstract

Objective: Analyze the cost-effectiveness of using Detemir versus using other insulins (Glargine and NPH insulin) for treatment of type 2 diabetes in Colombia. Methods: A Markov model was used to evaluate cost-effectiveness of Determir from a third-party payer's perspective in a hypothetical cohort of 10,000 patients, aged 45 years, with type 2 diabetes in risk of cardiovascular events and death in a 5-year time horizon. Both cardiovascular events and deaths avoided -expressed in Life-Year Saved- related to severe hypoglycemia events were considered as outcomes. Costs were obtained from health care providers databases at 2013 prices. A discount rate of 3% was applied to costs and outcomes. A sensitivity analysis was conducted to test the robustness of the model. Results: In the model, using Detemir has fewer numbers of severe hypoglycemic events (730) versus NPH insulin (1,910) and Glargine (2,140), and fewer number of macrovas-cular (1,053) and microvascular (1,019) events versus Glargine (1,116; 1,037) and NPH (1,129; 1,042). Using Detemir, 122 and 147 deaths were avoided compared to Glargine and NPH respectively; those figures are respectively equivalent to 4,233and 3,513 Life-Year Saved. As discount was applied the ICER per Life-Year Saved for Detemir versus Glargine was US$ 998.39 and USD 4,096.86 against NPHinsulin. In the Montecarlo sen-sitivity analysis Detemir remains cost effective in 100% of cases according to the WHO-proposed threshold. Conclusion: From a third-party payer's perspective,Detemir is cost-effective compared to Glargine and NPH insulin for treatment of type 2 diabetes in Colombia.