title: A clinical and health economic review of a prefilled insulin pen.
abstract: OBJECTIVE
  Several different durable or disposable insulin pen delivery devices are currently available, and newer, improved devices are being introduced. One prefilled insulin device, FlexPen (FP), has recently been improved (known as the Next Generation FlexPen (NGFP) in Europe or the improved FlexPen in the United States). The aim of this review is to summarize the clinical and health economic data of FP and its modified version.
  
  
  METHODS
  Relevant clinical and health economic terms relating to insulin pens were used to search Medline for studies and other publications involving FP and NGFP.
  
  
  RESULTS
  Sixteen publications investigating FP and/or the NGFP were identified. Patients prefer FP and are more confident with its use in comparison to vial/syringe insulin administration: in a study of 105 patients with type 1 or type 2 diabetes, 85% of patients found FP to be more discreet for use in public than a syringe, 74% of patients found FP to be easier to use overall and 82% of patients had more confidence with setting the correct dose with FP. Four publications investigated the dosing accuracy of FP or NGFP: all studies found the study doses for both were within ISO-specified limits. Pharmacoeconomic issues with insulin pen devices were identified in four papers, and switching to FP from vial/syringe was found to increase treatment adherence from 59% to 68% (p < 0.01), as measured by medication possession ratio. Switching to FP is also a cost-effective option for patients. Mean all-cause annual treatment (-$1748/patient, p < 0.01), hypoglycaemia-attributable costs (-$908/patient, p < 0.01), and other diabetes-attributable costs (-$643/patient, p < 0.01) were reduced following the switch from vial/syringe.
  
  
  CONCLUSIONS
  Some limitations of traditional insulin administration devices can be overcome with insulin pen devices. FP is a prefilled disposable pen that has been modified to further improve characteristics beneficial to patient insulin administration.
authors.affiliation: Department of Medicine/Diabetology and Endocrinology, Kuopio University Hospital, Kuopio, Finland. leo.niskanen@kuh.fi
authors.forename: L
authors.initials: L
authors.lastname: Niskanen
mesh_terms: D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics; D004209:Disposable Equipment / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D007267:Injections / Q000191:economics; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D007332:Insulin Infusion Systems / Q000009:adverse effects / Q000191:economics*; D013594:Syringes / Q000009:adverse effects / Q000191:economics*; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin