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Evaluation of the long-term cost-effectiveness of insulin detemir compared with neutral protamine hagedorn insulin in patients with type 1 diabetes using a basal-bolus regimen in Sweden

Valentine, William J ; Aagren, Mark ; Haglund, Mattias LU ; Ericsson, Asa and Gschwend, Manuela H (2011) In Scandinavian Journal of Public Health 39(1). p.79-87
Abstract

AIMS: To evaluate the long-term clinical and economic outcomes associated with insulin detemir and neutral protamine hagedorn (NPH) insulin in combination with mealtime insulin aspart in patients with type 1 diabetes in Sweden, based on data from a two-year, multi-national, open-label, randomized, controlled trial.

METHODS: Insulin detemir was associated with significant improvements in glycaemic control after 24 months (HbA1c 7.36% versus 7.58%, mean difference -0.22%, p = 0.022) and major hypoglycaemic events (69% risk reduction, p = 0.001) versus NPH. Patients treated with detemir gained less weight (1.7 versus 2.7 kg, P = 0.024). Based on these findings, a published and validated computer model (IMS CORE Diabetes Model) was... (More)

AIMS: To evaluate the long-term clinical and economic outcomes associated with insulin detemir and neutral protamine hagedorn (NPH) insulin in combination with mealtime insulin aspart in patients with type 1 diabetes in Sweden, based on data from a two-year, multi-national, open-label, randomized, controlled trial.

METHODS: Insulin detemir was associated with significant improvements in glycaemic control after 24 months (HbA1c 7.36% versus 7.58%, mean difference -0.22%, p = 0.022) and major hypoglycaemic events (69% risk reduction, p = 0.001) versus NPH. Patients treated with detemir gained less weight (1.7 versus 2.7 kg, P = 0.024). Based on these findings, a published and validated computer model (IMS CORE Diabetes Model) was used to estimate life-expectancy, quality-adjusted life expectancy and both direct medical costs and indirect costs.

RESULTS: Basal-bolus therapy with insulin detemir was projected to improve life expectancy by 0.14 years (15.02 ± 0.19 versus 14.88 ± 0.18 years) and quality-adjusted life expectancy by 0.53 quality-adjusted life years (QALYs) versus NPH (8.35 ± 0.11 versus 7.82 ± 0.10 QALYs). Improvements in QALYs were driven by avoided or delayed diabetes-related complications and fewer hypoglycaemic events. Direct medical costs over patient lifetimes were SEK 26,144 higher in the insulin detemir arm (SEK 995,025 ± 19,580 versus 968,881 ± 19,769), leading to an incremental cost-effectiveness ratio of SEK 49,757 per QALY gained. Capturing indirect costs led to insulin detemir being cost saving over patient lifetimes, by SEK 80,113, compared to NPH (SEK 2,959,909 ± 64,727 versus 3,040,022 ± 62,317).

CONCLUSIONS: Compared with NPH, insulin detemir is likely to be cost-effective from a healthcare payer perspective and dominant from a societal perspective in patients with type 1 diabetes in Sweden.

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author
; ; ; and
publishing date
type
Contribution to journal
publication status
published
keywords
Adult, Cohort Studies, Cost of Illness, Cost-Benefit Analysis, Diabetes Complications/economics, Diabetes Mellitus, Type 1/drug therapy, Drug Costs, Female, Health Care Costs, Humans, Hypoglycemic Agents/administration & dosage, Insulin/administration & dosage, Insulin Detemir, Insulin, Isophane/administration & dosage, Insulin, Long-Acting, Male, Outcome Assessment, Health Care, Quality-Adjusted Life Years, Sweden/epidemiology, Time Factors
in
Scandinavian Journal of Public Health
volume
39
issue
1
pages
9 pages
publisher
SAGE Publications
external identifiers
  • scopus:79952272856
  • pmid:20688795
ISSN
1651-1905
DOI
10.1177/1403494810379290
language
English
LU publication?
no
id
25f64651-c6f2-4682-ba8b-d12e6b1224b1
date added to LUP
2025-03-01 17:26:35
date last changed
2025-04-13 08:06:21
@article{25f64651-c6f2-4682-ba8b-d12e6b1224b1,
  abstract     = {{<p>AIMS: To evaluate the long-term clinical and economic outcomes associated with insulin detemir and neutral protamine hagedorn (NPH) insulin in combination with mealtime insulin aspart in patients with type 1 diabetes in Sweden, based on data from a two-year, multi-national, open-label, randomized, controlled trial.</p><p>METHODS: Insulin detemir was associated with significant improvements in glycaemic control after 24 months (HbA1c 7.36% versus 7.58%, mean difference -0.22%, p = 0.022) and major hypoglycaemic events (69% risk reduction, p = 0.001) versus NPH. Patients treated with detemir gained less weight (1.7 versus 2.7 kg, P = 0.024). Based on these findings, a published and validated computer model (IMS CORE Diabetes Model) was used to estimate life-expectancy, quality-adjusted life expectancy and both direct medical costs and indirect costs.</p><p>RESULTS: Basal-bolus therapy with insulin detemir was projected to improve life expectancy by 0.14 years (15.02 ± 0.19 versus 14.88 ± 0.18 years) and quality-adjusted life expectancy by 0.53 quality-adjusted life years (QALYs) versus NPH (8.35 ± 0.11 versus 7.82 ± 0.10 QALYs). Improvements in QALYs were driven by avoided or delayed diabetes-related complications and fewer hypoglycaemic events. Direct medical costs over patient lifetimes were SEK 26,144 higher in the insulin detemir arm (SEK 995,025 ± 19,580 versus 968,881 ± 19,769), leading to an incremental cost-effectiveness ratio of SEK 49,757 per QALY gained. Capturing indirect costs led to insulin detemir being cost saving over patient lifetimes, by SEK 80,113, compared to NPH (SEK 2,959,909 ± 64,727 versus 3,040,022 ± 62,317).</p><p>CONCLUSIONS: Compared with NPH, insulin detemir is likely to be cost-effective from a healthcare payer perspective and dominant from a societal perspective in patients with type 1 diabetes in Sweden.</p>}},
  author       = {{Valentine, William J and Aagren, Mark and Haglund, Mattias and Ericsson, Asa and Gschwend, Manuela H}},
  issn         = {{1651-1905}},
  keywords     = {{Adult; Cohort Studies; Cost of Illness; Cost-Benefit Analysis; Diabetes Complications/economics; Diabetes Mellitus, Type 1/drug therapy; Drug Costs; Female; Health Care Costs; Humans; Hypoglycemic Agents/administration & dosage; Insulin/administration & dosage; Insulin Detemir; Insulin, Isophane/administration & dosage; Insulin, Long-Acting; Male; Outcome Assessment, Health Care; Quality-Adjusted Life Years; Sweden/epidemiology; Time Factors}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{79--87}},
  publisher    = {{SAGE Publications}},
  series       = {{Scandinavian Journal of Public Health}},
  title        = {{Evaluation of the long-term cost-effectiveness of insulin detemir compared with neutral protamine hagedorn insulin in patients with type 1 diabetes using a basal-bolus regimen in Sweden}},
  url          = {{http://dx.doi.org/10.1177/1403494810379290}},
  doi          = {{10.1177/1403494810379290}},
  volume       = {{39}},
  year         = {{2011}},
}