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Exp Clin Endocrinol Diabetes 2014; 122(09): 517-522
DOI: 10.1055/s-0034-1376987
Article
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Health Economics Analysis of Insulin Aspart vs. Regular Human Insulin in Type 2 Diabetes Patients, Based on Observational Real life Evidence from General Practices in Germany

A. Liebl
1   Centre for Diabetes and Metabolism, Fachklinik Bad Heilbrunn, Bad Heilbrunn, Germany
,
L. Seitz
2   Novo Nordisk Pharma GmbH, Mainz
,
A. J. Palmer
3   Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, ­Australia
4   Critical Health Research Pty Ltd, Campania, Tasmania, Australia
› Author Affiliations
Further Information

Publication History

received 22 October 2013
first decision 04 April 2014

accepted 12 May 2014

Publication Date:
22 August 2014 (online)

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Abstract

Background: A retrospective analysis of German general practice data demonstrated that insulin aspart (IA) was associated with a significantly reduced incidence of macrovascular events (MVE: stroke, myocardial infarction, peripheral vascular disease or coronary heart disease) vs. regular human insulin (RHI) in type 2 diabetes patients. Economic implications, balanced against potential improvements in quality-adjusted life years (QALYs) resulting from lower risks of complications with IA in this setting have not yet been explored.

Methods: A decision analysis model was developed utilizing 3-year initial MVE rates for each comparator, combined with published German-specific insulin and MVE costs and health utilities to calculate number needed to treat (NNT) to avoid any MVE, incremental costs and QALYs gained/ person for IA vs. RHI. A 3-year time horizon and German 3rd-party payer perspective were used. Probabilistic sensitivity analysis was performed, sampling from distributions of key parameters. Additional sensitivity analyses were performed.

Results: NNT over a 3 year period to avoid any MVE was 8 patients for IA vs. RHI. Due to lower MVE rates, IA dominated RHI with 0.020 QALYs gained (95% confidence interval: 0.014–0.025) and cost savings of EUR 1 556 (1 062–2 076)/person for IA vs. RHI over the 3-year time horizon. Sensitivity analysis revealed that IA would still be overall cost saving even if the cost of IA was double the cost/unit of RHI.

Conclusions: From a health economics perspective, IA was the superior alternative for the insulin treatment of type 2 diabetes, with lower incidence of MVE events translating to improved QALYs and lower costs vs. RHI within a 3-year time horizon.

Key words

health economics - costs - insulin - Germany - diabetes - cardiovascular disease
 

  • References

  • 1 Liebl A. Costs involved in the early and late phases of diabetes mellitus. Internist (Berl) 2007; 48: 708-714
    CrossrefPubMedGoogle Scholar
  • 2 Martin S, Schramm W, Schneider B et al. Epidemiology of complications and total treatment costs from diagnosis of Type 2 diabetes in Germany (ROSSO 4). Exp Clin Endocrinol Diabetes 2007; 115: 495-501
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Koester I, Hauner H, von Ferber L. Heterogenität der Kosten bei Patienten mit Diabetes mellitus: Die KoDiM-Studie [Heterogeneity of costs of diabetic patients: the Cost of Diabetes Mellitus Study]. DtschMedWochenschr 2006; 131: 804-810
    PubMedGoogle Scholar
  • 4 Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med 2001; 161: 397-405
    CrossrefPubMedGoogle Scholar
  • 5 Nakagami T, Qiao Q, Tuomilehto J et al. Screen-detected diabetes, hypertension and hypercholesterolemia as predictors of cardiovascular mortality in five populations of Asian origin: the DECODA study. Eur J Cardiovasc Prev Rehabil 2006; 13: 555-561
    CrossrefPubMedGoogle Scholar
  • 6 Coutinho M, Gerstein HC, Wang Y et al. The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes Care 1999; 22: 233-240
    CrossrefPubMedGoogle Scholar
  • 7 Cavalot F, Pagliarino A, Valle M et al. Postprandial blood glucose predicts cardiovascular events and all-cause mortality in type 2 diabetes in a 14-year follow-up: lessons from the San Luigi Gonzaga Diabetes Study. Diabetes Care 2011; 34: 2237-2243
    CrossrefPubMedGoogle Scholar
  • 8 Scognamiglio R, Negut C, de Kreutzenberg SV et al. Effects of different insulin regimes on postprandial myocardial perfusion defects in type 2 diabetic patients. Diabetes Care 2006; 29: 95-100
    CrossrefPubMedGoogle Scholar
  • 9 Gallagher A, Home PD. The effect of improved post-prandial blood glucose control on post-prandial metabolism and markers of vascular risk in people with Type 2 diabetes. Diabetes Res Clin Pract 2005; 67: 196-203
    CrossrefPubMedGoogle Scholar
  • 10 Perriello G, Pampanelli S, Porcellati F et al. Insulin aspart improves meal time glycaemic control in patients with Type 2 diabetes: a randomized, stratified, double-blind and cross-over trial. Diabet Med 2005; 22: 606-611
    CrossrefPubMedGoogle Scholar
  • 11 Nishimura HSM, Maeda K, Ohtoshi M et al. Does multiple injection therapy (MIT) with an ultrarapid-acting insulin analogue prevent cardiovascualr disease in type 2 diabetes? The NICE study: A prospective, randomised, open-label, blinded endpoint study. Presented at the 68th Scientific Sessions of the American Diabetes Association, June 6-10, 2008; San Francisco, CA, USA.
    PubMedGoogle Scholar
  • 12 Becher HKK, Schröder-Bernhardi D. Validity and representativeness of the Disease Analyzer patient database for use in pharmacoepidemiological and pharmacoeconomic studies. Int J Clin Pharm Therap 2009; 47: 617-626
    PubMedGoogle Scholar
  • 13 Rathmann W, Kostev K. Lower incidence of recorded cardiovascular outcomes in patients with type 2 diabetes using insulin aspart vs. those on human regular insulin: observational evidence from general practices. Diabetes Obes Metab 2013; 15: 358-363
    CrossrefPubMedGoogle Scholar
  • 14 Faber-Heinemann GH, Hess E, von Huebbenet G et al. Insulin therapy for type 2 diabetes in Germany: Data from 41 specialized diabetes practices. Diabetes Stoffwechsel und Herz 2008; 17: 357-361
    PubMedGoogle Scholar
  • 15 Gemeinsamer Bundesausschuss. Arzneimittel-Richtlinie/Neuer Abschnitt I (Anlage 4/Insulin-Analogon Lispro und Anlage 10/Insulinanaloga). Beschlussdatum: 18.07.2006. Beschluss veröffentlicht: BAnz. Nr. 184 (S. 6527) vom 28.09.2006. http://www.g-ba.de/informationen/beschluesse/313/ last accessed September 3rd, 2013.
    PubMed
  • 16 Scheuringer MS, Krobot N, Ulrich KJ. Cost of clinical events in health economic evaluations in Germany: a systematic review. Cost Effectiveness and Resource Allocation http://wwwresource-allocationcom/content/10/1/7 2012 10(7)
    PubMedGoogle Scholar
  • 17 Brüggenjürgen BRH-J, Willich SN, Spannagl M et al. Cost of atherothrombotic diseases—myocardial infarction, ischaemic stroke and peripheral arterial occlusive disease—in Germany. Journal of Public Health 2005; 13: 216-224
    CrossrefPubMedGoogle Scholar
  • 18 Gesundheitsberichterstattung des Bundes ‘Gesundheitsausgaben in Deutschland als Anteil am BIP und in Mio. € (absolut und je Einwohner). Gliederungsmerkmale: Jahre’; available from http://www.gbe-bund.de/oowa921-install/servlet/oowa/aw92/WS0100/_XWD_PROC?_XWD_124/1/XWD_CUBE.DRILL/_XWD_152/D.000/3722 2012. Last accessed September 3rd, 2013.
    PubMed
  • 19 Clarke P, Gray A, Holman R. Estimating utility values for health states of type 2 diabetic patients using the EQ-5D (UKPDS 62). MedDecisMaking 2002; 22: 340-349
    PubMedGoogle Scholar
  • 20 Tengs TO, Wallace A. One thousand health-related quality-of-life estimates. MedCare 2000; 38: 583-637
    PubMedGoogle Scholar
  • 21 Koster I, Huppertz E, Hauner H et al. Direct costs of diabetes mellitus in Germany – CoDiM 2000-2007. Exp Clin Endocrinol Diabetes 2011; 119: 377-385
    Article in Thieme ConnectPubMedGoogle Scholar