title: A long-term analysis evaluating the cost-effectiveness of biphasic insulin lispro mix 75/25 and mix 50/50 versus long-acting basal insulin analogs in the United States.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of biphasic insulin lispro mix 75/25 (LM75/25) and mix 50/50 (LM50/50) compared with a long-acting analog insulin (LAAI) regimen from the perspective of a US healthcare payer.
  
  
  METHODS
  A published computer simulation model of diabetes was used to evaluate the cost-effectiveness of LM75/25 and LM50/50 vs a LAAI (insulin glargine) from the perspective of a US healthcare payer. Treatment effects in terms of HbA1c benefits were taken from a recent meta-analysis. Direct medical costs including pharmacy, complication, and patient management costs were obtained from published sources. All costs were expressed in 2010 US dollars and future costs and clinical benefits were discounted at 3% per annum. Sensitivity analyses were performed.
  
  
  RESULTS
  LM75/25 and LM50/50 were associated with improvements in life expectancy of 0.08 and 0.09 years, improvements in quality-adjusted life expectancy of 0.07 quality-adjusted life years (QALYs) and 0.08 QALYs and increases in cost of US$ 1724 and US$ 1720, respectively, when compared with LAAI.
  
  
  CONCLUSIONS
  The base case analysis did not capture mild or serious hypoglycemia on the grounds that the hypoglycemia rate odds ratios failed to reach statistical significance in the meta-analysis. In addition, the baseline cohort characteristics were based on an insulin-naïve population, as opposed to the cohorts in the meta-analysis, which were heterogeneous with regard to insulin treatment history.
  
  
  CONCLUSIONS
  Based on a recently published meta-analysis, biphasic analog insulins are likely to improve clinical outcomes and reduce costs vs LAAIs in the long-term treatment of type 2 diabetes patients in the US.
authors.affiliation: Ossian Health Economics and Communications, Basel, Switzerland. pollock@ossianconsulting.com
authors.forename: Richard F
authors.initials: RF
authors.lastname: Pollock
authors.forename: Bradley H
authors.initials: BH
authors.lastname: Curtis
authors.forename: William J
authors.initials: WJ
authors.lastname: Valentine
mesh_terms: D003198:Computer Simulation; D003362:Cost-Benefit Analysis / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D005260:Female; D005102:Health Expenditures / Q000639:trends; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D061268:Insulin Lispro / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D008017:Life Expectancy; D008134:Long-Term Care / Q000191:economics; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D019057:Quality-Adjusted Life Years; D014481:United States
chemical_list: D007004:Hypoglycemic Agents; D061268:Insulin Lispro