title: Evaluation of the long-term cost-effectiveness of insulin detemir compared with neutral protamine hagedorn insulin in patients with type 1 diabetes using a basal-bolus regimen in Sweden.
abstract: OBJECTIVE
  To evaluate the long-term clinical and economic outcomes associated with insulin detemir and neutral protamine hagedorn (NPH) insulin in combination with mealtime insulin aspart in patients with type 1 diabetes in Sweden, based on data from a two-year, multi-national, open-label, randomized, controlled trial.
  
  
  METHODS
  Insulin detemir was associated with significant improvements in glycaemic control after 24 months (HbA1c 7.36% versus 7.58%, mean difference -0.22%, p = 0.022) and major hypoglycaemic events (69% risk reduction, p = 0.001) versus NPH. Patients treated with detemir gained less weight (1.7 versus 2.7 kg, P = 0.024). Based on these findings, a published and validated computer model (IMS CORE Diabetes Model) was used to estimate life-expectancy, quality-adjusted life expectancy and both direct medical costs and indirect costs.
  
  
  RESULTS
  Basal-bolus therapy with insulin detemir was projected to improve life expectancy by 0.14 years (15.02 ± 0.19 versus 14.88 ± 0.18 years) and quality-adjusted life expectancy by 0.53 quality-adjusted life years (QALYs) versus NPH (8.35 ± 0.11 versus 7.82 ± 0.10 QALYs). Improvements in QALYs were driven by avoided or delayed diabetes-related complications and fewer hypoglycaemic events. Direct medical costs over patient lifetimes were SEK 26,144 higher in the insulin detemir arm (SEK 995,025 ± 19,580 versus 968,881 ± 19,769), leading to an incremental cost-effectiveness ratio of SEK 49,757 per QALY gained. Capturing indirect costs led to insulin detemir being cost saving over patient lifetimes, by SEK 80,113, compared to NPH (SEK 2,959,909 ± 64,727 versus 3,040,022 ± 62,317).
  
  
  CONCLUSIONS
  Compared with NPH, insulin detemir is likely to be cost-effective from a healthcare payer perspective and dominant from a societal perspective in patients with type 1 diabetes in Sweden.
authors.affiliation: Ossian Health Economics and Communication, Basel, Switzerland.
authors.forename: William J
authors.initials: WJ
authors.lastname: Valentine
authors.forename: Mark
authors.initials: M
authors.lastname: Aagren
authors.forename: Mattias
authors.initials: M
authors.lastname: Haglund
authors.forename: Asa
authors.initials: A
authors.lastname: Ericsson
authors.forename: Manuela H
authors.initials: MH
authors.lastname: Gschwend
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000191:economics / Q000401:mortality / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000191:economics; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D000069057:Insulin Detemir; D007336:Insulin, Isophane / Q000008:administration & dosage* / Q000191:economics; D049528:Insulin, Long-Acting; D008297:Male; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years; D013548:Sweden / Q000453:epidemiology / Q000208:ethnology; D013997:Time Factors
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D000069057:Insulin Detemir; D007336:Insulin, Isophane