title: Healthcare costs of fast-acting insulin analogues versus short-acting human insulin for Danish patients with type 2 diabetes on a basal-bolus regimen.
abstract: OBJECTIVE
  Fast-acting insulin analogues (FAIAs) reduce hypoglycaemia and improve administration flexibility compared with short-acting human insulin (SHI). This analysis examines whether these benefits translate into cost offsets when comparing the total treatment costs for FAIA versus SHI used as basal-bolus therapy for treating type 2 diabetes (T2D).
  
  
  METHODS
  Registry data covering the Danish population including demographic variables, prescription, hospital and primary care data formed the basis for analysis. To capture patients on basal-bolus therapy only, inclusion criteria were ≥2 prescriptions of either long-acting insulin analogues (LAIAs) or neutral protamine Hagedorn (NPH) insulin (basal component), and ≥2 prescriptions for either an FAIA or SHI (bolus component) during the inclusion period (1 January-31 December 2005). Patients using LAIAs (n = 521) or NPH (n = 2695) were analysed separately. Within each basal cohort, patients using FAIAs or SHI were matched regarding observable variables using propensity scores. Healthcare costs were analysed for a follow-up period (maximum 2 years post-inclusion).
  
  
  RESULTS
  Within each cohort, matching produced groups with similar observed covariates. Overall direct healthcare costs in the LAIA cohort were €4183 and €5289 for FAIA and SHI, respectively. In the NPH cohort, costs were €4940 and €4699 for FAIA and SHI, respectively. For both basal cohorts, cost differences between FAIA and SHI were not statistically significant.
  
  
  CONCLUSIONS
  As the propensity score model cannot account for unobserved variables, conclusions of causality cannot be made. Moreover, exclusion of indirect costs and application of hospital contact charges accrued in the discharge year only may result in an underestimation of overall healthcare costs.
  
  
  CONCLUSIONS
  Using matched cohorts, treating patients with T2D using basal-bolus regimens containing FAIAs was no more costly to the Danish healthcare system than regimens using SHI. FAIAs provide a flexible administration and optimal glucose control for a similar cost.
authors.affiliation: Novo Nordisk A/S, Vandtaarnsvej 114, Soeborg, Denmark. tluc@novonordisk.com
authors.forename: Torsten E
authors.initials: TE
authors.lastname: Christensen
authors.forename: Jens
authors.initials: J
authors.lastname: Gundgaard
authors.forename: Trine
authors.initials: T
authors.lastname: Pilgaard
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D003718:Denmark; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007328:Insulin / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D007336:Insulin, Isophane / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors
chemical_list: D007328:Insulin; D007336:Insulin, Isophane