A clinical and health economic review of a prefilled insulin pen

Abstract

Objective:

Several different durable or disposable insulin pen delivery devices are currently available, and newer, improved devices are being introduced. One prefilled insulin device, FlexPen (FP), has recently been improved (known as the Next Generation FlexPen (NGFP) in Europe or the improved FlexPen in the United States). The aim of this review is to summarize the clinical and health economic data of FP and its modified version.

Methods:

Relevant clinical and health economic terms relating to insulin pens were used to search Medline for studies and other publications involving FP and NGFP.

Results:

Sixteen publications investigating FP and/or the NGFP were identified. Patients prefer FP and are more confident with its use in comparison to vial/syringe insulin administration: in a study of 105 patients with type 1 or type 2 diabetes, 85% of patients found FP to be more discreet for use in public than a syringe, 74% of patients found FP to be easier to use overall and 82% of patients had more confidence with setting the correct dose with FP. Four publications investigated the dosing accuracy of FP or NGFP: all studies found the study doses for both were within ISO-specified limits. Pharmacoeconomic issues with insulin pen devices were identified in four papers, and switching to FP from vial/syringe was found to increase treatment adherence from 59% to 68% (p < 0.01), as measured by medication possession ratio. Switching to FP is also a cost-effective option for patients. Mean all-cause annual treatment (−$1748/patient, p < 0.01), hypoglycaemia-attributable costs (−$908/patient, p < 0.01), and other diabetes-attributable costs (−$643/patient, p < 0.01) were reduced following the switch from vial/syringe.

Conclusions:

Some limitations of traditional insulin administration devices can be overcome with insulin pen devices. FP is a prefilled disposable pen that has been modified to further improve characteristics beneficial to patient insulin administration.

Key words:

• Diabetes
• FlexPen
• Insulin
• Insulin pen

Transparency

Declaration of funding

L.N. did not receive any honoraria for writing this article. Novo Nordisk provided funding to Watermeadow Medical UK for writing and editorial assistance.

Declaration of financial/other relationships

L.N. has held paid lectures and commercially sponsored research for Eli Lilly, Merck, Novo Nordisk, Boehringer Ingelheim, AstraZeneca, sanofi-aventis, Bristol-Myers Squibb, Pfizer, and Janssen-Cilag, and is an advisory board member for Novo Nordisk, Novartis, and AstraZeneca.

Peer reviewers may receive honoraria from CMRO for their review work. Peer Reviewer 1 has disclosed that he/she is a stock shareholder in AstraZeneca and GlaxoSmithKline. Peer Reviewer 2 has disclosed no relevant financial relationships.

Acknowledgements

The author would like to thank Liz Southey and Georgina Grell of Watermeadow Medical, UK, for writing and editorial assistance, which was funded by Novo Nordisk.