title: Long-term cost-effectiveness of insulin detemir versus NPH insulin in type 2 diabetes in Sweden.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of insulin detemir vs. NPH insulin once daily, in patients with type 2 diabetes in the Swedish setting based on clinical data from a published randomized controlled trial.
  
  
  METHODS
  Projections of long-term outcomes were made using the IMS CORE Diabetes Model (CDM), based on clinical data from a 26-week randomized controlled trial that compared once daily insulin detemir and NPH insulin, when used to intensify insulin treatment in 271 patients with type 2 diabetes and body mass index (BMI) 25-40 kg/m(2). Trial results showed that insulin detemir was associated with a significantly lower incidence of hypoglycemic events and significantly less weight gain in comparison with NPH insulin. The analysis was conducted from a third party payer perspective and the base case analysis was performed over a time horizon of 40 years and future costs and clinical outcomes were discounted at a rate of 3% per year.
  
  
  RESULTS
  Insulin detemir was associated with higher mean (SD) quality-adjusted life expectancy (5.42 [0.10] vs. 5.31 [0.10] quality-adjusted life years [QALYs]) and lower overall costs (SEK 378,539 [10,372] vs. SEK 384,216 [11,230]; EUR 33,794 and EUR 34,300, respectively, where 1 EUR=11.2015 SEK) compared with NPH insulin. Sensitivity analysis showed that the principal driver of the benefits associated with insulin detemir was the lower rate of hypoglycemic events (major and minor events) vs. NPH insulin, suggesting that detemir might also be cost-saving over a shorter time horizon. Limitations of the analysis include the use of data from a trial outside Sweden in the Swedish setting.
  
  
  CONCLUSIONS
  Based on clinical input data derived from a previously published randomized controlled trial, it is likely that in the Swedish setting insulin detemir would be cost-saving in comparison with NPH insulin for the treatment of patients with type 2 diabetes.
authors.affiliation: Ossian Health Economics and Communications, Basel, Switzerland. smith-palmer@ossianconsulting.com
authors.forename: J
authors.initials: J
authors.lastname: Smith-Palmer
authors.forename: C
authors.initials: C
authors.lastname: Fajardo-Montañana
authors.forename: R F
authors.initials: RF
authors.lastname: Pollock
authors.forename: A
authors.initials: A
authors.lastname: Ericsson
authors.forename: W J
authors.initials: WJ
authors.lastname: Valentine
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics*; D000069057:Insulin Detemir; D007336:Insulin, Isophane / Q000008:administration & dosage / Q000191:economics*; D049528:Insulin, Long-Acting / Q000008:administration & dosage / Q000191:economics*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D000069057:Insulin Detemir; D007336:Insulin, Isophane