title: Evaluation of insulin use and value for money in type 2 diabetes in the United kingdom.
abstract: BACKGROUND
  It is unclear as to whether human or long-acting analog insulins represent the most efficient use of health and non-healthcare resources in the management of type 2 diabetes mellitus (T2DM). The aim of this study was to evaluate the value for money relationship associated with the use of these insulins in the UK setting.
  
  
  METHODS
  A literature search was performed for studies reporting expenditure associated with the use of human and analog insulins. Data from this review informed a budget impact assessment model. Costs were converted to a common currency and results are reported in 2011 British pounds sterling (GBP) values.
  
  
  RESULTS
  Annual diabetes-related medication expenditure and patients total expenditure associated with the management of T2DM were estimated to be £397 million and £3,901 million, respectively. Substitution of human insulin for analog insulins was associated with a drug acquisition cost saving of between £5 million and £23 million each year. Overall, though, total expenditure increased significantly with increased use of human insulin by £34 million to £136 million each year depending on the degree of substitution.
  
  
  CONCLUSIONS
  On the face of it, analog insulins are more expensive, prompting questions about potential cost savings to health services in the UK from direct substitution to the less expensive human preparation. The current analysis illustrates that the increased use of human insulin and decreased use of analog insulin would, however, increase the overall net societal cost of managing insulin-treated patients with T2DM. Governments and decision makers should consider that total healthcare expenditure would not necessarily fall when decisions are based solely on the use of cheaper products.
authors.affiliation: Department of Public Health, University of Adelaide, Level 7, 178 North Terrace, Adelaide, SA, 5005, Australia, jason.gordon@adelaide.edu.au.
authors.forename: Jason
authors.initials: J
authors.lastname: Gordon
authors.forename: Marc
authors.initials: M
authors.lastname: Evans
authors.forename: Phil
authors.initials: P
authors.lastname: McEwan
authors.forename: Steve
authors.initials: S
authors.lastname: Bain
authors.forename: Jiten
authors.initials: J
authors.lastname: Vora