Abstract
BackgroundInternational guidelines recommend using basal insulin in patients with type-2 diabetes mellitus if glycaemic target cannot be attained on non-insulin anti-diabetic drugs. Available choices of basal insulin include intermediate-acting neutral protamine Hagedorn (NPH) insulin and long-acting insulin analogues like insulin glargine U100. Despite clear advantages of glargine U100, the existing practice in Hong Kong still favours NPH insulin due to lower immediate drug costs.ObjectivesThe objective of this study was to assess the cost-effectiveness of insulin glargine U100 compared to NPH insulin in patients with type-2 diabetes uncontrolled with non-insulin anti-diabetic agents alone in Hong Kong.MethodsThe IQVIA™ Core Diabetes Model (CDM) v9.0 was used to conduct the cost-effectiveness analysis of glargine U100 versus NPH. Baseline characteristics were collected from the Hong Kong Diabetes Registry. Efficacy rates were extracted from a published study comparing glargine U100 and NPH in Asia, utilities from published literature, and costs constructed using the Hong Kong Hospital Authority (HA) Gazette (public healthcare setting). The primary outcome was an incremental cost-effectiveness ratio (ICER).ResultsInsulin glargine U100 resulted in an ICER of HKD 98,663 per Quality Adjusted Life Year (QALY) gained. The incremental gains in QALY and costs were 0.217 years and HKD 21,360 respectively. Results from scenario and probabilistic sensitivity analyses were consistent with that from base case analysis.ConclusionInsulin glargine U100 is a cost-effective treatment for patients with type 2 diabetes compared to NPH insulin in setting in Hong Kong. This was mainly driven by the significantly lower rates of hypoglycaemia of insulin glargine U100 than NPH insulin.
Highlights
International guidelines recommend using basal insulin in patients with type-2 diabetes mellitus if glycaemic target cannot be attained on non-insulin anti-diabetic drugs
Insulin glargine U100 is a cost-effective treatment for patients with type 2 diabetes compared to neutral protamine Hagedorn (NPH) insulin in setting in Hong Kong
Patients treated with glargine U100 suffered significantly fewer hypoglycaemic episodes (Additional file 1: Table S2), incurring lower costs (HKD 39,338) than patients treated with NPH (HKD 57,962) (Additional file 1: Table S1)
Summary
International guidelines recommend using basal insulin in patients with type-2 diabetes mellitus if glycaemic target cannot be attained on non-insulin anti-diabetic drugs. Despite clear advantages of glargine U100, the existing practice in Hong Kong still favours NPH insulin due to lower immediate drug costs. Despite clear advantages of long-acting insulin analogues such as glargine U100 over NPH, the existing practice in Hong Kong public healthcare setting still favours NPH due to lower immediate drug costs. The results of the present analysis are intended to add further insights to the existing pharmacoeconomic research in diabetes mellitus in Asia and to support an informed decision to widen the use of insulin glargine U100 in the public setting in Hong Kong which will improve patients’ quality of life while relaxing the pressure on the healthcare budget
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