Abstract
BackgroundCompared to conventional human basal insulin (neutral protamine Hagedorn; NPH) the long-acting analogue insulin glargine (GLA) is associated with a number of advantages regarding metabolic control, hypoglycaemic events and convenience. However, the unit costs of GLA exceed those of NPH. This study aims to systematically review the economic evidence comparing GLA with NPH in basal-bolus treatment (intensified conventional therapy; ICT) of type 1 diabetes in order to facilitate informed decision making in clinical practice and health policy.MethodsA systematic literature search was performed for the period of January 1st 2000 to December 1st 2009 via Embase, Medline, the Cochrane Library, the databases GMS (German Medical Science) and DAHTA (Deutsche Agentur für Health Technology Assessment), and the abstract books of relevant international scientific congresses. Retrieved studies were reviewed based on predefined inclusion criteria, methodological and quality aspects. In order to allow comparison between studies, currencies were converted using purchasing power parities (PPP).ResultsA total of 7 health economic evaluations from 4 different countries fulfilled the predefined criteria: 6 modelling studies, all of them cost-utility analyses, and one claims data analysis with a cost-minimisation design. One cost-utility analysis showed dominance of GLA over NPH. The other 5 cost-utility analyses resulted in additional costs per quality adjusted life year (QALY) gained for GLA, ranging from € 3,859 to € 57,002 (incremental cost effectiveness ratio; ICER). The cost-minimisation analysis revealed lower annual diabetes-specific costs in favour of NPH from the perspective of the German Statutory Health Insurance (SHI).ConclusionsThe incremental cost-utility-ratios (ICER) show favourable values for GLA with considerable variation. If a willingness-to-pay threshold of £ 30,000 (National Institute of Clinical Excellence, UK) is adopted, GLA is cost-effective in 4 of 6 cost utility analyses (CUA) included. Thus insulin glargine (GLA) seems to offer good value for money. Comparability between studies is limited because of methodological and country specific aspects. The results of this review underline that evaluation of insulin therapy should use evidence on efficacy of therapy from information synthesis. The concept of relating utility decrements to fear of hypoglycaemia is a plausible approach but needs further investigation. Also future evaluations of basal-bolus insulin therapy should include costs of consumables such as needles for insulin injection as well as test strips and lancets for blood glucose self monitoring.
Highlights
Compared to conventional human basal insulin the long-acting analogue insulin glargine (GLA) is associated with a number of advantages regarding metabolic control, hypoglycaemic events and convenience
A hand search in the German Diabetology journals was conducted for the years 2007 to 2009 as well as in abstract books of relevant international scientific congresses: the abstract databases of the Annual European respectively the Annual International Congresses of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), of the Annual Scientific Sessions of the American Diabetes Association (ADA), of the Annual International Meetings and the of the Annual Meetings of the European Association for the Study of Diabetes (EASD), and of the Annual Meeting of the German Diabetes Society (DDG) were scanned for relevant studies during the period of 2007 to 2009
We conducted a systematic review of health economic evaluations comparing GLA versus NPH as the basal component of an intensive conventional treatment (ICT) in type 1 diabetes. 7 economic evaluations from 4 different countries (Germany, Canada, England, Switzerland) were included: 6 cost-utility analyses based on complex modelling and 1 cost-comparison analysis based on claims data
Summary
Compared to conventional human basal insulin (neutral protamine Hagedorn; NPH) the long-acting analogue insulin glargine (GLA) is associated with a number of advantages regarding metabolic control, hypoglycaemic events and convenience. This study aims to systematically review the economic evidence comparing GLA with NPH in basal-bolus treatment (intensified conventional therapy; ICT) of type 1 diabetes in order to facilitate informed decision making in clinical practice and health policy. The aim of diabetes therapy has always been to mimic the basal and mealtime components of endogenous insulin secretion. Since intensive conventional treatment (ICT) was introduced in the 1960s this was achieved by applying short-acting and intermediate-acting human insulin [1]. As a third option the first synthetic long-acting insulin analogue insulin glargine (GLA) was approved by the European Medicines Agency (EMA) and Food and Drug Administration (FDA) in 2000 [2]. It is closer to the physiological insulin release than intermediate-acting NPH insulin [3]
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