Evaluating the Cost-Effectiveness of Reduced Mild Hypoglycaemia in Subjects With Type 1 Diabetes Treated With Insulin Detemir or NPH Insulin in Denmark, Sweden, Finland and the Netherlands

Diabet Med. 2012 Mar;29(3):303-12. doi: 10.1111/j.1464-5491.2011.03461.x.

Abstract

Aims: To estimate short-term cost-effectiveness of insulin detemir vs. NPH insulin based on the incidence of mild hypoglycaemia in subjects with Type 1 diabetes in Denmark, Sweden, Finland and the Netherlands.

Methods: A model was developed to evaluate cost-effectiveness based on mild (self-treated) hypoglycaemia and pharmacy costs over 1 year. Published rates of mild hypoglycaemia were used for NPH insulin and insulin detemir. Effectiveness was calculated in terms of quality-adjusted life expectancy. Pharmacy costs were accounted using published prices and defined daily doses for both insulins. Costs were expressed in 2010 euros (€).

Results: Treatment with insulin detemir was associated with fewer mild hypoglycaemic events than NPH insulin (mean rates of 26.3 vs. 35.5 events per person-year), leading to an improvement in mean quality-adjusted life expectancy of approximately 0.019 (0.030) quality-adjusted life years (standard deviation). Annual costs were € 573.55 (110.42) vs. € 332.76 (62.18) in Denmark for insulin detemir and NPH insulin, respectively. These values were € 545.79 (106.54) vs. € 306.12 (57.78) in Sweden, € 720.10 (140.74) vs. € 408.73 (78.61) in Finland and € 584.01 (109.47) vs. € 359.60 (64.84) in the Netherlands. Incremental cost-effectiveness ratios were approximately € 12,644 (Denmark), € 12,612 (Sweden), € 16,568 (Finland) and € 12,216 (the Netherlands) per quality-adjusted life year gained for insulin detemir vs. NPH insulin.

Conclusions: Insulin detemir is likely to be cost-effective vs. NPH insulin in subjects with Type 1 diabetes in Denmark, Sweden, Finland and the Netherlands. Increased pharmacy costs with insulin detemir should not be a barrier to therapy based on these findings.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cost-Benefit Analysis
  • Denmark
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / drug therapy
  • Diabetes Mellitus, Type 1 / economics*
  • Female
  • Finland
  • Humans
  • Hypoglycemia / drug therapy
  • Hypoglycemia / economics*
  • Hypoglycemic Agents / economics*
  • Hypoglycemic Agents / therapeutic use
  • Insulin Detemir
  • Insulin, Isophane / economics*
  • Insulin, Isophane / therapeutic use
  • Insulin, Long-Acting / economics*
  • Insulin, Long-Acting / therapeutic use
  • Male
  • Netherlands
  • Pharmacies / economics*
  • Quality-Adjusted Life Years
  • Sweden

Substances

  • Hypoglycemic Agents
  • Insulin, Long-Acting
  • Insulin Detemir
  • Insulin, Isophane