[Costs of diabetes care and treatment satisfaction in type 2 diabetes patients treated with a basal-bolus (ICT) insulin regimen in outpatient care: results of the LIVE-COM study].
OBJECTIVE
Costs for diabetes treatment burden statutory health care systems. Aim of the LIVE-COM study (Long Acting Insulin Glargine versus Insulin Detemir Cost Evaluation Comparison) was to assess resource utilization and costs of diabetes care as well as patient reported outcomes in a random sample of type 2 diabetes patients treated with either insulin glargine (GLA) or detemir (DET) as part of a basal-bolus regimen in a primary care setting.


METHODS
LIVE-COM is a non-interventional, cross-sectional study performed between April and September 2008 in 138 randomly selected centers of primary care physicians in Germany. From 1731 type 2 diabetes patients (GLA: n = 1150; DET: n = 581) with statutory health insurance status and pretreatment with either GLA or DET for at least 6 months as part of a basal-bolus therapy, total direct costs of diabetes care (for insulins, oral antidiabetic drugs, test strips, needles, lancets, Hypokits®) were calculated from total recorded expenditures, for a period of six months, from the perspective of statutory health insurance. Patient-reported outcomes were assessed using validated questionnaires (SF-12, DTSQs, ITEQ).


RESULTS
Mean total costs per patient over six months were lower with GLA based therapy compared with DET based therapy (972 euro ± 374 euro vs. 1135 euro ± 477 euro, p < 0.001). Adjusted by ANCOVA: 932 euro (95% CI: 905, 957 euro) vs. 1.061 euro (95% CI: 1025, 1099 euro, p < 0.001). The adjusted mean single costs for basal insulin (223 euro vs. 246 euro), bolus insulin (241 euro vs. 289 euro), test strips (347 euro vs. 393 euro) and needles (67 euro vs. 80 euro) were significantly lower in the GLA group (p < 0.001, each), whereas costs of OAD (36 euro vs. 35 euro), lancets (14 euro vs. 15 euro) and Hypokits® (1.9 euro vs. 1.0 euro) did not differ significantly. Glycemic parameters (HbA1c, fasting blood glucose) were better on GLA based therapy (p < 0.01) and associated with lower daily total insulin doses (68 U vs. 79 U). Furthermore, slightly better results in patient-reported outcomes were found in GLA patients.


CONCLUSIONS
In a head-to-head comparison over six months a glargine vs. detemir based basal-bolus therapy in type 2 diabetes patients was associated with lower total costs of diabetes care Δ: -128 euro/patient) mainly caused by savings of consumables. Further health services research with larger sample sizes should be conducted to obtain a more comprehensive analysis of economic aspects of insulin analogs or other innovative drugs in routine practice.
Ambulantes Diabeteszentrum am Elisabeth-Krankenhaus, Essen, Germany.
Ralph Achim
RA
Bierwirth
Thomas
T
Kohlmann
Jörn
J
Moock
Rolf
R
Holle
Wolfgang
W
Landgraf
D000368:Aged; D000553:Ambulatory Care / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics*; D005260:Female; 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 / Q000008:administration & dosage* / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000191:economics
D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine; D000069057:Insulin Detemir