title: Evaluating the cost-effectiveness of reduced mild hypoglycaemia in subjects with Type 1 diabetes treated with insulin detemir or NPH insulin in Denmark, Sweden, Finland and the Netherlands.
abstract: OBJECTIVE
  To estimate short-term cost-effectiveness of insulin detemir vs. NPH insulin based on the incidence of mild hypoglycaemia in subjects with Type 1 diabetes in Denmark, Sweden, Finland and the Netherlands.
  
  
  METHODS
  A model was developed to evaluate cost-effectiveness based on mild (self-treated) hypoglycaemia and pharmacy costs over 1 year. Published rates of mild hypoglycaemia were used for NPH insulin and insulin detemir. Effectiveness was calculated in terms of quality-adjusted life expectancy. Pharmacy costs were accounted using published prices and defined daily doses for both insulins. Costs were expressed in 2010 euros (€).
  
  
  RESULTS
  Treatment with insulin detemir was associated with fewer mild hypoglycaemic events than NPH insulin (mean rates of 26.3 vs. 35.5 events per person-year), leading to an improvement in mean quality-adjusted life expectancy of approximately 0.019 (0.030) quality-adjusted life years (standard deviation). Annual costs were € 573.55 (110.42) vs. € 332.76 (62.18) in Denmark for insulin detemir and NPH insulin, respectively. These values were € 545.79 (106.54) vs. € 306.12 (57.78) in Sweden, € 720.10 (140.74) vs. € 408.73 (78.61) in Finland and € 584.01 (109.47) vs. € 359.60 (64.84) in the Netherlands. Incremental cost-effectiveness ratios were approximately € 12,644 (Denmark), € 12,612 (Sweden), € 16,568 (Finland) and € 12,216 (the Netherlands) per quality-adjusted life year gained for insulin detemir vs. NPH insulin.
  
  
  CONCLUSIONS
  Insulin detemir is likely to be cost-effective vs. NPH insulin in subjects with Type 1 diabetes in Denmark, Sweden, Finland and the Netherlands. Increased pharmacy costs with insulin detemir should not be a barrier to therapy based on these findings.
authors.affiliation: Ossian Health Economics and Communications GmbH, Basel, Switzerland. valentine@ossianconsulting.com
authors.forename: W J
authors.initials: WJ
authors.lastname: Valentine
authors.forename: J
authors.initials: J
authors.lastname: Jendle
authors.forename: M
authors.initials: M
authors.lastname: Saraheimo
authors.forename: B
authors.initials: B
authors.lastname: Thorsteinsson
authors.forename: R F
authors.initials: RF
authors.lastname: Pollock
authors.forename: M
authors.initials: M
authors.lastname: Lammert
mesh_terms: D003362:Cost-Benefit Analysis; D003718:Denmark; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D005260:Female; D005387:Finland; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy / Q000191:economics*; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D000069057:Insulin Detemir; D007336:Insulin, Isophane / Q000191:economics* / Q000627:therapeutic use; D049528:Insulin, Long-Acting / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D009426:Netherlands; D010594:Pharmacies / Q000191:economics*; D019057:Quality-Adjusted Life Years; D013548:Sweden
chemical_list: D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D000069057:Insulin Detemir; D007336:Insulin, Isophane