Cost-effectiveness of switching to biphasic insulin aspart from human premix insulin in a US setting

Figures & data

Table 1.  Baseline demographics, complications, relevant concomitant mediations and management of patients in the simulated cohort.

	Mean	SD	Reference
Demographics
Sex (% male)	62.0		*
Mean age (years)	64.2	11.0	*
BMI (kg/m^2)	32.1	6.7	*
Mean duration of diabetes (years)	16.4	8.9	*
Racial characteristics
Proportion White	64.0		[25]
Proportion Black	19.0		[25]
Proportion Hispanic	7.0		[25]
Risk factors
HbA1c (% points)	8.4	1.6	*
Systolic blood pressure (mmHg)	136.4	17.1	[25]
Total cholesterol (mg/dL)	183.3	41.9	[25]
High density lipoprotein-cholesterol  (mg/dL)	41.8	10.8	[25]
Low density lipoprotein-cholesterol  (mg/dL)	104.9	33.9	[25]
Triglycerides (mg/dL)	155.0	NR	[25]
Pre-existing complications
Myocardial infarction (%)	27.0		[40]
Stroke (%)	8.0		*
PVD	14.0		*
Microalbuminuria (%)	27.0		*
Background retinopathy (%)	24.0		*
Macular oedema (%)	2.0		[40]
Neuropathy (%)	25.0		*
Management
Taking ACE-I (%)	53.0		[25]
Taking statins (%)	62.0		[25]

SD, standard deviation; BMI, body mass index; HbA_1c, glycohaemoglobin; PVD, peripheral vascular disease; ACE–I, angiotensin-converting enzyme inhibitor; *IMPROVE data from the Canadian patients switched to biphasic insulin aspart from human premix insulin (n = 311) as supplied by Novo Nordisk Inc.; NR, not reported.

Table 2.  Treatment associated effects with BIAsp 30 and BHI 30.

	BIAsp 30		BHI 30
	Mean	SD	Mean	SD
Change in HbA1c (%-points)	−0.58	1.32	0.00	0.00
Change in BMI (kg/m^2)	0.28	2.33	0.00	0.00
Major hypoglycaemia rate (events per 100 patient-years)	7.7		30.9
Minor hypoglycaemia rate (events per 100 patient-years)	1116.1		1638.6

BIAsp 30, biphasic insulin aspart; BHI 30, biphasic human insulin 30; SD, standard deviation; HbA_1c, glycohaemoglobin; BMI, body mass index.

Table 3.  Cost data for treatment and hospitalisation of type 2 diabetes complications and patient management in the US for 2008.

Event	Cost in first year (USD)	Cost in following years (USD)	Reference
Non-fatal MI	39,481	2182	[27]
Non-fatal stroke	52,282	17,449	[27]
Angina	7832	2023	[27]
CHF	3391	3391	[27]
Peripheral vascular disease	4965	0	[27]
Haemodialysis	68,000	68,000	[26]
Peritoneal dialysis	49,000	49,000	[26]
Kidney transplant	24,000	24,000	[26]
Major hypoglycaemia	289	0	[27]
Retinal photocoagulation	879	0	[27]
Cataract operation	2801	0	[27]
Blindness	4261	4261	[27]
Neuropathy	430	0	[27]
Amputation	35,086	1261	[27]
Infected ulcer (per month cost)	281	0	[27]
Non-infected ulcer (per month cost)	156	0	[27]
Management
Annual eye screening	87		[27]
Annual screening for microalbuminuria	19		[27]

USD, US dollars; MI, myocardial infarction; CHF, congestive heart failure.

Table 4.  Summary of base-case results for BIAsp 30 versus BHI 30.

Outcome	BIAsp 30	BHI 30	Difference
Undiscounted life expectancy (years)	9.537 (0.232)	9.335 (0.239)	0.202
Discounted life expectancy (years)	7.597 (0.161)	7.473 (0.169)	0.124
Quality-adjusted life expectancy (QALYs)	4.605 (0.101)	4.304 (0.101)	0.301
Direct medical costs ($)	76,517 (2359)	67,518 (2375)	8998
ICER	USD 29,870 per QALY gained

BIAsp 30, biphasic insulin aspart; BHI 30, biphasic human insulin 30; QALY, quality-adjusted life-year; ICER, incremental cost-effectiveness ratio; USD, US dollars. Values shown are means with standard deviation in parentheses.

Figure 1. Cumulative incidence of diabetes-related complications for BIAsp 30 versus BHI 30. BIAsp 30, biphasic insulin aspart 30; BHI 30, biphasic human insulin; MAU, microalbuminuria; ESRD, end-stage renal disease; SVL, severe vision loss; MI, myocardial infarction; CHF, congestive heart failure; PVD, peripheral vascular disease; Major hypo, major hypoglycaemia.

Figure 2. Scatter-plot of incremental costs and effectiveness values for BIAsp 30 versus BHI 30. BIAsp 30, biphasic insulin aspart; BHI 30, biphasic human insulin 30; USD, US dollars; QALY, quality-adjusted life-years.

Figure 3. Acceptability curve for BIAsp 30 versus BHI 30. BIAsp 30, biphasic insulin aspart; BHI 30, biphasic human insulin 30; USD, Us dollars.

Table 5.  Sensitivity analyses for BIAsp 30 versus BHI 30 on cost-effectiveness outcomes.

	Quality-adjusted life expectancy (QALYs)			Lifetime direct medical costs (USD)			ICER (USD per QALY gained)
	BIAsp 30	BHI 30	Difference	BIAsp 30	BHI 30	Difference
Base case	4.605	4.304	0.301	76,517	67,518	8998	29,870
	(0.101)	(0.101)		(2359)	(2375)
5-year time horizon	2.282	2.179	0.103	33,182	28,782	4400	42,577
	(0.034)	(0.031)		(921)	(874)
10-year time horizon	3.548	3.364	0.184	54,422	47,715	6707	36,440
	(0.067)	(0.058)		(1498)	(1548)
15-year time horizon	4.202	3.954	0.248	66,667	58,996	7671	30,966
	(0.086)	(0.083)		(1925)	(1916)
20-year time horizon	4.472	4.202	0.271	72,844	64,622	8221	30,353
	(0.102)	(0.091)		(2188)	(2158)
25-year time horizon	4.575	4.279	0.296	75,599	66,767	8832	29,887
	(0.104)	(0.093)		(2345)	(2260)
No discounting	5.753	5.347	0.406	98,573	87,084	11,489	28,271
	(0.143)	(0.140)		(3342)	(3338)
6% discounting	3.808	3.575	0.233	61,706	54,354	7353	31,598
	(0.075)	(0.077)		(1781)	(1811)
20% increase in diabetes-related	4.605	4.304	0.301	84,824	76,354	8470	28,116
complication costs	(0.101)	(0.101)		(2740)	(2788)
20% decrease in diabetes-related	4.605	4.304	0.301	68,209	58,682	9527	31,624
complication costs	(0.101)	(0.101)		(1982)	(1966)
Probabilistic sensitivity analysis	4.461	4.181	0.280	75,591	66,909	8681	31,030
	(1.173)	(1.091)		(15,248)	(13,991)
HbA1c reduction halved	4.544	4.304	0.240	76,829	67,518	9311	38,767
	(0.103)	(0.101)		(2497)	(2375)
No reduction in HbA1c	4.470	4.304	0.166	77,248	67,518	9730	58,462
	(0.101)	(0.101)		(2370)	(2375)
Hypoglycaemia reduction halved	4.507	4.304	0.203	77,343	67,518	9824	48,396
	(0.102)	(0.101)		(2320)	(2375)
No reduction in hypoglycaemia	4.410	4.304	0.106	77,720	67,518	10,202	95,819
	(0.108)	(0.101)		(2363)	(2375)

BIAsp 30, biphasic insulin aspart; BHI 30, biphasic human insulin 30; QALY, quality-adjusted life-year; ICER, incremental cost-effectiveness ratio; USD, US dollars; HbA_1c, glycohaemoglobin. Values shown are means with standard deviation in parentheses.

Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358: 2545–2559

 PubMed Web of Science ®Google Scholar

Brandle M, Zhou H, Smith BR, et al. The direct medical cost of type 2 diabetes. Diabetes Care 2003; 26: 2300–2304

 PubMed Web of Science ®Google Scholar

Minshall ME, Oglesby AK, Wintle ME, et al. Estimating the long-term cost-effectiveness of exenatide in the United States: an adjunctive treatment for type 2 diabetes mellitus. Value Health 2008; 11: 22–33

 PubMed Web of Science ®Google Scholar

Foley RN, Collins AJ. End-stage renal disease in the United States: an update from the United States Renal Data System. J Am Soc Nephrol 2007; 18: 2644–2648

 PubMed Web of Science ®Google Scholar