Cost comparison of insulin glargine with insulin detemir in a basal-bolus regime with mealtime insulin aspart in type 2 diabetes in Germany.
OBJECTIVE
To compare the treatment costs of insulin glargine (IG; Lantus) to detemir (ID; Levemir), both combined with bolus insulin aspart (NovoRapid) in type 2 diabetes (T2D) in Germany.


METHODS
Cost comparison was based on data of a 1-year randomised controlled trial. IG was administered once daily and ID once (57% of patients) or twice daily (43%) according to treatment response. At the end of the trial, mean daily basal insulin doses were 0.59 U/kg (IG) and 0.82 U/kg (ID). Aspart doses were 0.32 U/kg (IG) and 0.36 U/kg (ID). Costs were calculated from the German statutory health insurance (SHI) perspective using official 2008 prices. Sensitivity analyses were performed to test robustness of the results.


RESULTS
Annual basal and bolus insulin costs per patient were euro 1,473 (IG) and euro 1,940 (ID). The cost of lancets and blood glucose test strips were euro 1,125 (IG) and euro 1,286 (ID). Annual costs for needles were euro 393 (IG) and euro 449 (ID). The total annual cost per patient of administering IG was euro 2,991 compared with euro 3,675 for ID, translating into a 19% annual cost difference of euro 684/patient. Base case results were robust to varying assumptions for insulin dose, insulin price, change in weight and proportion of ID once daily administrations.


CONCLUSIONS
IG and ID basal-bolus regimes have comparative safety and efficacy, based on the Hollander study, IG however may represent a significantly more cost saving option for T2D patients in Germany requiring basal-bolus insulin analogue therapy with potential annual cost savings of euro 684/patient compared to ID.
Pscherer
Stefan
S
Klinikum Traunstein, Germany.
Dietrich
Eva Susanne
ES
Dippel
Franz-Werner
FW
Neilson
Aileen Rae
AR
D015190:Blood Glucose Self-Monitoring / Q000191:economics; D017046:Cost Savings; D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D016527:Drug Costs / Q000706:statistics & numerical data; D005858:Germany; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D017059:Models, Econometric; D009339:Needles / Q000191:economics; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D011934:Reagent Strips / Q000191:economics
D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D011934:Reagent Strips; D000069036:Insulin Glargine; D000069057:Insulin Detemir