title: Cost-effectiveness of switching to biphasic insulin aspart from human premix insulin in a US setting.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of switching to biphasic insulin aspart (BIAsp 30) from human premix insulin for type 2 diabetes patients in the United States (US) setting.
  
  
  METHODS
  The previously published and validated IMS Core Diabetes Model was used to project life expectancy, quality-adjusted life expectancy (QALE) and costs over 30 years. Patient characteristics and treatment effects were based on Canadian patients included the IMPROVE observational study (n = 311). Mean glycohaemoglobin (HbA(1c)) was 8.4%, duration of diabetes 16 years and prevalence of complications high at baseline. Simulations were conducted from the perspective of a third-party payer, with costs accounted in 2008 US dollars ($).
  
  
  RESULTS
  BIAsp 30 was projected to improve life expectancy by 0.202 years and QALE by 0.301 quality-adjusted life-years (QALYs), due to a reduced incidence of most diabetes-related complications. BIAsp 30 was associated with increased lifetime direct medical costs ($76,517 vs. 67,518) and an incremental cost-effectiveness ratio of $29,870 per QALY gained. Long-term outcomes were sensitive to the impact of BIAsp 30 on hypoglycaemia and changes in HbA(1c).
  
  
  CONCLUSIONS
  BIAsp 30 may represent a cost-effective treatment option in the US setting for advanced type 2 diabetes patients experiencing poor glycaemic control or hypoglycaemia on human premix insulin.
  
  
  CONCLUSIONS
  The application of treatment effect data derived from a Canadian cohort to the US setting was a limitation of the cost-effectiveness analysis. The findings of this cost-effectiveness analysis are not applicable to insulin-naïve diabetes patients.
authors.affiliation: IMS Health, CORE–Center for Outcomes Research GmbH, Gewerbestrasse 25, Allschwil, Switzerland. jpalmer@ch.imshealth.com
authors.forename: James L
authors.initials: JL
authors.lastname: Palmer
authors.forename: Martin S
authors.initials: MS
authors.lastname: Knudsen
authors.forename: Mark
authors.initials: M
authors.lastname: Aagren
authors.forename: Trine L
authors.initials: TL
authors.lastname: Thomsen
mesh_terms: D061265:Biphasic Insulins; D015992:Body Mass Index; D002170:Canada; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D007328:Insulin / Q000031:analogs & derivatives* / Q000191:economics* / Q000627:therapeutic use; D061267:Insulin Aspart; D007336:Insulin, Isophane; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D017060:Patient Satisfaction; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D014481:United States
chemical_list: D061265:Biphasic Insulins; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D061267:Insulin Aspart; D007336:Insulin, Isophane; C557564:insulin aspart, insulin aspart protamine drug combination 30:70