Evaluating the cost-effectiveness of insulin detemir versus neutral protamine Hagedorn insulin in patients with type 1 or type 2 diabetes in the UK using a short-term modeling approach

Figures & data

Table 1 Unit costs in the base-case analysis

	Cost	Cost basis	Reference
NPH insulin (GBP per IU)	0.015	Insulatard Penfill^® cartridge 100 IU/mL, 5×3 mL	BNF, September 2016
Insulin detemir (GBP per IU)	0.028	Levemir^® Penfill^® cartridge 100 IU/mL, 5×3 mL	BNF, September 2016
Bolus insulin (GBP per IU)	0.019	NovoRapid^® Penfill^® cartridge 100 IU/mL, 5×3 mL	BNF, September 2016
Metformin (GBP per gram)	0.027	Metformin tablets, 850 mg, 56 tablet pack	BNF, September 2016
Gliclazide (GBP per milligram)	0.003	Gliclazide tablets, 40 mg, 28 tablet pack	BNF, September 2016
Needles (GBP per needle)	0.03	BD Micro-Fine 0.3 mm/30 gauge, 200 needle pack	NHS BSA, September 2016
SMBG test strip (GBP per strip)	0.319	Accu-Chek Aviva, 50 strip pack	NHS BSA, September 2016
Lancet (GBP per lancet)	0.049	FastClix (Roche Diabetes Care Ltd), 204 lancet pack	NHS BSA, September 2016
Hypoglycemic event T1D (GBP)	2.193	Additional strips and HCP contacts	^Citation33
Hypoglycemic event T2D (GBP)	3.066	Additional strips and HCP contacts	^Citation33

Abbreviations: NPH, neutral protamine Hagedorn; BD, Becton Dickinson; GBP, 2016 pounds sterling; HCP, health care professional; IU, international units; NHS BSA, National Health Service Business Services Authority; SMBG, self-monitoring of blood glucose; BNF, British National Formulary; T1D, type 1 diabetes; T2D, type 2 diabetes.

Table 2 Cost-effectiveness of insulin detemir versus NPH insulin in the UK

	NPH insulin cost (GBP)	Insulin detemir cost (GBP)	Incremental cost (GBP)	NPH effectiveness (QALYs)	Insulin detemir effectiveness (QALYs)	Incremental effectiveness (QALYs)	ICER (GBP per QALY gained)
Type 1 diabetes	1,241	1,301	+60	0.192	0.291	0.099	610
Type 2 diabetes	627	798	+171	0.520	0.640	0.120	1,422

Abbreviations: GBP, 2016 pounds sterling; NPH, neutral protamine Hagedorn; QALY, quality-adjusted life year; ICER, incremental cost-effectiveness ratio.

Figure 1 Cost-effectiveness scatter plot for insulin detemir relative to NPH insulin in patients with type 1 diabetes.

Abbreviations: NPH, neutral protamine Hagedorn; QALY, quality-adjusted life year; GBP, 2016 pounds sterling.

Figure 2 Cost-effectiveness acceptability curve for insulin detemir relative to NPH insulin in patients with type 1 diabetes.

Abbreviations: NPH, neutral protamine Hagedorn; QALY, quality-adjusted life year; GBP, 2016 pounds sterling.

Figure 3 Cost-effectiveness scatter plot for insulin detemir relative to NPH insulin in patients with type 2 diabetes.

Abbreviations: NPH, neutral protamine Hagedorn; QALY, quality-adjusted life year; GBP, 2016 pounds sterling.

Figure 4 Cost-effectiveness acceptability curve for insulin detemir relative to NPH insulin in patients with type 2 diabetes.

Abbreviations: NPH, neutral protamine Hagedorn; QALY, quality-adjusted life year; GBP, 2016 pounds sterling.

Table 3 One-way sensitivity analysis results

	NPH insulin cost (GBP)	Insulin detemir cost (GBP)	Incremental cost (GBP)	NPH effectiveness (QALYs)	Insulin detemir effectiveness (QALYs)	Incremental effectiveness (QALYs)	ICER (GBP per QALY gained)
Type 1 diabetes
Base case	1,241	1,301	+60	0.192	0.291	+0.099	610
Hypoglycemia rate ratio of 0.78^Citation21	1,266	1,301	+35	0.144	0.291	+0.147	238
Levy et al hypoglycemia disutility^Citation7	1,241	1,301	+60	0.312	0.392	+0.080	757
Currie et al hypoglycemia disutility^Citation10	1,241	1,301	+60	0.282	0.367	+0.084	714
Diminishing hypoglycemia utility	1,241	1,301	+60	0.733	0.737	+0.004	13,578
UKHSG base hypoglycemia rate	1,003	1,101	+98	0.637	0.664	+0.028	3,550
Type 2 diabetes
Base case	627	798	+171	0.520	0.640	+0.120	1,422
No BMI disutility	627	798	+171	0.522	0.640	+0.118	1,446
Hypoglycemia rate ratio of 0.7^Citation39	593	798	+205	0.565	0.640	+0.075	2,735
Levy et al hypoglycemia disutility^Citation7	627	798	+171	0.576	0.673	+0.097	1,760
Currie et al hypoglycemia disutility^Citation10	627	798	+171	0.562	0.665	+0.103	1,661
Diminishing hypoglycemia utility	627	798	+171	0.748	0.760	+0.012	14,533
Eliasson et al insulin doses^Citation33	594	770	+175	0.520	0.640	+0.120	1,459
UKHSG base hypoglycemia rate	432	683	+251	0.780	0.793	+0.014	18,429

Abbreviations: GBP, 2016 pounds sterling; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life year; UKHSG, UK Hypoglycemia Study Group; NPH, neutral protamine Hagedorn; BMI, body mass index.

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