Abstract
IntroductionIt is unclear as to whether human or long-acting analog insulins represent the most efficient use of health and non-healthcare resources in the management of type 2 diabetes mellitus (T2DM). The aim of this study was to evaluate the value for money relationship associated with the use of these insulins in the UK setting.MethodsA literature search was performed for studies reporting expenditure associated with the use of human and analog insulins. Data from this review informed a budget impact assessment model. Costs were converted to a common currency and results are reported in 2011 British pounds sterling (GBP) values.ResultsAnnual diabetes-related medication expenditure and patients total expenditure associated with the management of T2DM were estimated to be £397 million and £3,901 million, respectively. Substitution of human insulin for analog insulins was associated with a drug acquisition cost saving of between £5 million and £23 million each year. Overall, though, total expenditure increased significantly with increased use of human insulin by £34 million to £136 million each year depending on the degree of substitution.ConclusionsOn the face of it, analog insulins are more expensive, prompting questions about potential cost savings to health services in the UK from direct substitution to the less expensive human preparation. The current analysis illustrates that the increased use of human insulin and decreased use of analog insulin would, however, increase the overall net societal cost of managing insulin-treated patients with T2DM. Governments and decision makers should consider that total healthcare expenditure would not necessarily fall when decisions are based solely on the use of cheaper products.
Highlights
IntroductionP. McEwan HEOR Consulting Ltd, Singleton Court Business Park, Wonastow Rd, Monmouth, UK
It is unclear as to whether human or long-acting analog insulinsJ
The purpose of this study was to extend the analysis of human versus analog basal insulin to illustrate the limitations of analyses that, we argue, improperly restrict the decision context to the results of randomized trials and drug acquisition cost
Summary
P. McEwan HEOR Consulting Ltd, Singleton Court Business Park, Wonastow Rd, Monmouth, UK. Unlike people with type 1 diabetes, who require insulin, people with T2DM can initially manage their condition without pharmacological intervention. The natural history of T2DM, characterized by progressive decline in beta cell function, results in an inevitable need for multiple pharmacotherapies including oral antidiabetic drugs (OADs), insulin, or both, in order to optimize blood glucose control [2]. Over the course of the UK Prospective Diabetes Study (UKPDS),[50% people treated with sulfonylureas required additional insulin to maintain fasting plasma glucose levels \6 mmol/L, within 6 years of T2DM diagnosis [3]. Insulin initiation early within the natural history of T2DM is endorsed by professional bodies including the American Diabetes Association (ADA) and the European
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