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ABSTRACT
Background: People with type 2 diabetes typically require insulin treatment following failure on hypoglycaemic agents. The purpose of this study was to evaluate the relative cost-effectiveness of insulin glargine versus NPH insulin for the treatment of type 2 diabetes in the UK. Insulin glargine has been shown to reduce the likelihood of hypoglycaemia and improve HbA1c in type 2 diabetes by comparison with NPH insulin.
Methods: The study used a discrete event simulation model designed to forecast the costs and health outcome of a cohort of 1000 subjects over 40 years. The two main scenarios involved a difference in the likelihood of hypoglycaemia or a difference in HbA1c. Prices were in UK£ 2005 costs. Costs and benefits were discounted at 3.5% per year. Effectiveness data were pooled data from randomised clinical trials.
Results: The incremental cost–effectiveness ratio of insulin glargine versus NPH insulin was £10 027 per quality adjusted life year under a differential hypoglycaemia-only scenario. The incremental cost–effectiveness ratio of insulin glargine versus NPH insulin was £13 921 per quality adjusted life year under a differential HbA1c-only scenario. In wide-ranging sensitivity analysis, the ICER was consistently below £20 000 per quality adjusted life year gained.
Conclusion: This study was the first to evaluate the relative cost-effectiveness of insulin glargine versus NPH insulin. Insulin glargine resulted in significant health benefits and represents excellent value for money for the treatment of type 2 diabetes in the UK.