Insulin therapy in type 2 diabetes patients failing oral agents: Cost-effectiveness of biphasic insulin aspart 70/30 vs. insulin glargine in the US

Joshua A. Ray, W. J. Valentine, S. Roze, I. Nicklasson, D. Cobden, Philip Raskin, A. Garber, A. J. Palmer

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objectives: To project the long-term clinical and economic outcomes of treatment with biphasic insulin aspart 30 (BIAsp 70/30, 30% soluble and 70% protaminated insulin aspart) vs. insulin glargine in insulin-naïve type 2 diabetes patients failing to achieve glycemic control with oral antidiabetic agents alone (OADs). Methods: Baseline patient characteristics and treatment effect data from the recent 'INITIATE' clinical trial served as input to a peer-reviewed, validated Markov/Monte-Carlo simulation model. INITIATE demonstrated improvements in HbA1c favouring BIAsp 70/30 vs. glargine (-0.43%; p < 0.005) and greater efficacy in reaching glycaemic targets among patients poorly controlled on OAD therapy. Effects on life expectancy (LE), quality-adjusted life expectancy (QALE), cumulative incidence of diabetes-related complications and direct medical costs (2004 USD) were projected over 35 years. Clinical outcomes and costs were discounted at a rate of 3.0% per annum. Sensitivity analyses were performed. Results: Improvements in glycaemic control were projected to lead to gains in LE (0.19 ± 0.24 years) and QALE (0.19 ± 0.17 years) favouring BIAsp 70/30 vs. glargine. Treatment with BIAsp 70/30 was also associated with reductions in the cumulative incidences of diabetes-related complications, notably in renal and retinal conditions. The incremental cost-effectiveness ratio was $46 533 per quality-adjusted life year gained with BIAsp 70/30 vs. glargine (for patients with baseline HbA1c ≥ 8.5%, it was $34 916). Total lifetime costs were compared to efficacy rates in both arms as a ratio, which revealed that the lifetime cost per patient treated successfully to target HbA1c levels of <7.0% and ≤ 6.5% were $80 523 and $93 242 lower with BIAsp 70/30 than with glargine, respectively. Conclusions: Long-term treatment with BIAsp 70/30 was projected to be cost-effective for patients with type 2 diabetes insufficiently controlled on OADs alone compared to glargine. Treatment with BIAsp 70/30 was estimated to represent an appropriate investment of healthcare dollars in the management of type 2 diabetes.

Original languageEnglish (US)
Pages (from-to)103-113
Number of pages11
JournalDiabetes, Obesity and Metabolism
Volume9
Issue number1
DOIs
StatePublished - Jan 2007

Fingerprint

Type 2 Diabetes Mellitus
Cost-Benefit Analysis
Insulin
Life Expectancy
Costs and Cost Analysis
Therapeutics
Diabetes Complications
Insulin Aspart
Quality of Life
insulin aspart, insulin aspart protamine drug combination 30:70
Insulin Glargine
Quality-Adjusted Life Years
Incidence
Hypoglycemic Agents
Economics
Clinical Trials
Delivery of Health Care
Kidney

Keywords

  • Biphasic insulin aspart
  • Cost-effectiveness
  • Costs
  • INITIATE
  • Insulin glargine
  • Modeling
  • US

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Insulin therapy in type 2 diabetes patients failing oral agents : Cost-effectiveness of biphasic insulin aspart 70/30 vs. insulin glargine in the US. / Ray, Joshua A.; Valentine, W. J.; Roze, S.; Nicklasson, I.; Cobden, D.; Raskin, Philip; Garber, A.; Palmer, A. J.

In: Diabetes, Obesity and Metabolism, Vol. 9, No. 1, 01.2007, p. 103-113.

Research output: Contribution to journalArticle

Ray, Joshua A. ; Valentine, W. J. ; Roze, S. ; Nicklasson, I. ; Cobden, D. ; Raskin, Philip ; Garber, A. ; Palmer, A. J. / Insulin therapy in type 2 diabetes patients failing oral agents : Cost-effectiveness of biphasic insulin aspart 70/30 vs. insulin glargine in the US. In: Diabetes, Obesity and Metabolism. 2007 ; Vol. 9, No. 1. pp. 103-113.
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