title: Cost implications of the use of basal insulin glargine in people with early dysglycemia: the ORIGIN trial.
abstract: OBJECTIVE
  The cost implications of the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial were evaluated using a prespecified analysis plan.
  
  
  METHODS
  Purchasing power parity-adjusted country-specific costs were applied to consumed healthcare resources by participants from each country. Subgroup analyses were conducted on subgroups based on baseline metabolic status and diabetes duration.
  
  
  RESULTS
  The total undiscounted cost per participant in the insulin glargine arm was $13,491 ($13,080 to $14,254) versus $11,189 ($10,568 to $12,147) for standard care, an increase of $2303 ($1370 to $3235; p < 0.0001); the discounted increase was $2099 ($1276 to $2923; P < 0.0001). The greater number of mainly generic oral anti-diabetic agents in the standard group partially offset the higher cost of basal insulin glargine. As the trial progressed and the standard group required more anti-diabetic medications, the annual cost difference decreased, reaching $68 (-$160 to $295) in the last year. The subgroup whose baseline diabetes duration was ≥ 6 years achieved cost-savings during the trial.
  
  
  CONCLUSIONS
  From a global perspective basal insulin glargine use in ORIGIN incurred greater costs than standard care using older generic drugs. Nevertheless, the cost difference fell with time such that the intervention was cost-neutral by the last year.
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; CADENCE Research Group, Hamilton Health Sciences, Hamilton, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. Electronic address: lamya@mcmaster.ca.
authors.forename: A
authors.initials: A
authors.lastname: Lamy
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; CADENCE Research Group, Hamilton Health Sciences, Hamilton, Ontario, Canada.
authors.forename: W
authors.initials: W
authors.lastname: Tong
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Jung
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Gafni
authors.affiliation: All India Institute of Medical Sciences, New Delhi; Centre for Chronic Disease Control, New Delhi.
authors.forename: K
authors.initials: K
authors.lastname: Singh
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Tyrwhitt
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Yusuf
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: H C
authors.initials: HC
authors.lastname: Gerstein
mesh_terms: D002318:Cardiovascular Diseases / Q000191:economics / Q000401:mortality / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control* / Q000628:therapy; D003925:Diabetic Angiopathies / Q000191:economics / Q000401:mortality / Q000517:prevention & control; D058065:Diabetic Cardiomyopathies / Q000191:economics / Q000401:mortality / Q000517:prevention & control; D018450:Disease Progression; D016527:Drug Costs; D005500:Follow-Up Studies; D014943:Global Health / Q000191:economics; D018149:Glucose Intolerance / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology / Q000628:therapy; D017048:Health Care Costs; D006801:Humans; D006943:Hyperglycemia / Q000191:economics / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use*; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000191:economics / Q000627:therapeutic use*; D011236:Prediabetic State / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors
chemical_list: D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine
keywords: Costs; Insulin glargine