title: Cost of severe hypoglycaemia in patients with type 1 diabetes in Spain and the cost-effectiveness of insulin lispro compared with regular human insulin in preventing severe hypoglycaemia.
abstract: OBJECTIVE
  To determine the costs of severe hypoglycaemia (SH) in a population of patients with type 1 diabetes mellitus in the Spanish healthcare system and the cost-effectiveness of insulin lispro over regular insulin in preventing SH episodes.
  
  
  METHODS
  A retrospective study of 100 patients in three Spanish health centres was performed. Resource utilisation data were collected only for interventions specifically relating to the hypoglycaemic episode. The direct medical costs determined in the analyses were: costs of hospitalisation, diagnostic tests carried out, costs of treatment administered and other associated costs such as visits to the endocrinologist and re-training in glucose control, transportation and assistance of a care-giver. In addition, indirect costs such as days of lost productivity were measured. The incidence rates of SH for insulin lispro and regular insulin were obtained from the literature. The incremental cost-effectiveness of insulin lispro over regular insulin was calculated.
  
  
  RESULTS
  The overall mean cost per episode of SH was 366 euro, comprised of 65.4% direct costs and 35.6% indirect costs. The largest cost was for hospitalisation at 183 euro per episode. The SH episodes incidence rates for 100 patients per year were 33 and 73 for insulin lispro and 48 (p < 0.05) and 117 (p < 0.01) for regular insulin, in the two clinical trials found in the literature. The additional cost to prevent one episode of SH with insulin lispro over regular insulin ranged from 277 euro to insulin lispro dominance.
  
  
  CONCLUSIONS
  Severe hypoglycaemia has a significant impact on the total cost of diabetes. The use of insulin lispro is associated with reductions in annual costs because of SH and, possibly, the overall effect may be cost neutral or cost saving when total costs are considered. The cost of SH should be included in the analysis of total socio-economic burden of diabetes.
authors.affiliation: Medical Department, Lilly S.A., Madrid, Spain. reviriego_jesus@lilly.com
authors.forename: J
authors.initials: J
authors.lastname: Reviriego
authors.forename: R
authors.initials: R
authors.lastname: Gomis
authors.forename: J P
authors.initials: JP
authors.lastname: Marañés
authors.forename: W
authors.initials: W
authors.lastname: Ricart
authors.forename: P
authors.initials: P
authors.lastname: Hudson
authors.forename: J A
authors.initials: JA
authors.lastname: Sacristán
mesh_terms: D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000191:economics*; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007003:Hypoglycemia / Q000191:economics*; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D007328:Insulin / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D061268:Insulin Lispro; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013030:Spain; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D061268:Insulin Lispro