title: Direct costs associated with initiating NPH insulin versus glargine in patients with type 2 diabetes: a retrospective database analysis.
abstract: OBJECTIVE
  To compare total costs and risk of hypoglycemia in patients with type 2 diabetes (T2D) initiated on NPH insulin versus glargine in a real-world setting.
  
  
  METHODS
  This study used claims data (10/2001 to 06/2005) from a privately insured U.S. population of adult T2D patients who were initiated on NPH or glargine following a 6-month insulin-free period. A sample of 1698 glargine-treated and 400 NPH-treated patients met the inclusion criteria. Total and diabetes-related costs (inflation-adjusted to 2006) were calculated for 6-month pre- and post-index periods and compared between 400 patient pairs matched by a propensity score method.
  
  
  RESULTS
  In the post-index 6-month period, glargine patients incurred higher diabetes-related drug costs than NPH patients ($785 versus $632, p<0.0001) but there were no significant differences in diabetes-related medical or total costs, or all other total cost categories. Compared to the pre-index period, glargine patient costs declined by $2420 (p=0.058) whereas NPH patient costs declined by $4200 (p=0.046), with no statistically significant group differences (p=0.469). Among patients with hypoglycemia-related claims (0.75% in both groups), mean hypoglycemia-related costs were $85 and $202 for NPH and glargine patients, respectively (p=0.564).
  
  
  CONCLUSIONS
  Initiation of either NPH or glargine was associated with major cost reductions and infrequent hypoglycemia-related claims.
authors.affiliation: Eli Lilly and Company, Global Health Outcomes, Indianapolis, IN, USA.
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Lee
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Yu
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Johnson
authors.forename: Howard G
authors.initials: HG
authors.lastname: Birnbaum
authors.forename: Pavel
authors.initials: P
authors.lastname: Atanasov
authors.forename: Don P
authors.initials: DP
authors.lastname: Buesching
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Jackson
authors.forename: Jaime A
authors.initials: JA
authors.lastname: Davidson
mesh_terms: D000328:Adult; D048909:Diabetes Complications / Q000191:economics / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics; D004358:Drug Therapy / Q000191:economics; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000191:economics / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000069036:Insulin Glargine; D007336:Insulin, Isophane / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D049528:Insulin, Long-Acting; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011336:Probability; D057216:Propensity Score; D012189:Retrospective Studies; D014481:United States
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine; D007336:Insulin, Isophane