| 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. | |
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MedLine Citation:
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PMID: 20688795 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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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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Authors:
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William J Valentine; Mark Aagren; Mattias Haglund; Asa Ericsson; Manuela H Gschwend |
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Publication Detail:
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Type: Journal Article Date: 2010-08-05 |
Journal Detail:
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Title: Scandinavian journal of public health Volume: 39 ISSN: 1651-1905 ISO Abbreviation: Scand J Public Health Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-01-26 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100883503 Medline TA: Scand J Public Health Country: Sweden |
Other Details:
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Languages: eng Pagination: 79-87 Citation Subset: IM |
Affiliation:
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Ossian Health Economics and Communication, Basel, Switzerland. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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