Modeling the lifetime costs of insulin glargine and insulin detemir in type 1 and type 2 diabetes patients in Canada: a meta-analysis and a cost-minimization analysis

Abstract

Background:

Two basal insulin analogues, insulin glargine once daily and insulin detemir once or twice daily, are marketed in Canada.

Objective:

To estimate the long-term costs of insulin glargine once daily (QD) versus insulin detemir once or twice daily (QD or BID) for type 1 (T1DM) and type 2 (T2DM) diabetes mellitus from a Canadian provincial government’s perspective.

Methods:

A cost-minimization analysis comparing insulin glargine (IGlarg) to insulin detemir (IDet) was conducted using a validated computer simulation model, the CORE Diabetes Model. Lifetime direct medical costs including costs of insulin treatment and diabetes complications were projected. T1DM and T2DM patients’ daily insulin dose (T1DM: IGlarg QD 26.2 IU; IDet BID 33.6 IU; T2DM: IGlarg QD 47.2 IU; IDet QD 65.7 IU or IDet BID 80.4 IU) was derived from a meta-analysis of randomized trials. All patients were assumed to stay on the same treatment for life. Costs were discounted at 5% per annum and reported in 2010 Canadian Dollars.

Results:

The meta-analysis showed T1DM and T2DM patients had similar HbA_1c change from baseline when receiving IGlarg compared to IDet (T1DM: 0.002%-points; p = 0.97; T2DM: −0.05%-points; p = 0.28). Treatment of T1DM patients with IGlarg versus IDet BID resulted in lifetime cost savings of $4231 per patient. Treatment of T2DM patients with IGlarg resulted in lifetime cost savings of $4659 per patient versus IDet QD and cost savings of $8709 per patient versus IDet BID.

Conclusions:

Similar HbA_1c change from baseline can be achieved with a lower IGlarg than IDet dose. From the perspective of a Canadian provincial government, treatment of T1DM and T2DM patients with IGlarg instead of IDet can generate long-term cost savings. Main limitations include trial data were derived from multi-country studies rather than the Canadian population and self-monitoring blood glucose costs were not included.

Key words::

• Canada
• Costs
• Diabetes
• Insulin analogue
• Insulin detemir
• Insulin glargine
• Modeling

Transparency

Declaration of funding:

The funding for the study and manuscript preparation was provided by Sanofi-Aventis, Canada. The sponsor had no decisive role in the conduct of the cost-minimization analysis and in the meta-analysis. The sponsor did provide editorial assistance for the manuscript. Although results, interpretations and conclusions were not dictated by the sponsor, the paper did receive sponsor approval prior to submission.

Declaration of financial/other relationships

JV is an employee of Sanofi-Aventis, who sponsored the preparation of the manuscript. A-L.G., Y.S., D.W. and T.N. are employees of IMS Health and have no relationship (financial, employment, other significant/relevant relationships) with the sponsor.

Acknowledgments

The authors wish to thank Luc Sauriol from Sanofi-Aventis for his advice and Corinne Le Reun for performing the meta-analysis.

Notes

*Lantus is a registered trademark of Sanofi-Aventis Inc., USA.

†Levemir is a registered trademark of Novo Nordisk A/S, Bagsværd, Denmark.