title: Health economics analysis of insulin aspart vs. regular human insulin in type 2 diabetes patients, based on observational real life evidence from general practices in Germany.
abstract: BACKGROUND
  A retrospective analysis of German general practice data demonstrated that insulin aspart (IA) was associated with a significantly reduced incidence of macrovascular events (MVE: stroke, myocardial infarction, peripheral vascular disease or coronary heart disease) vs. regular human insulin (RHI) in type 2 diabetes patients. Economic implications, balanced against potential improvements in quality-adjusted life years (QALYs) resulting from lower risks of complications with IA in this setting have not yet been explored.
  
  
  METHODS
  A decision analysis model was developed utilizing 3-year initial MVE rates for each comparator, combined with published German-specific insulin and MVE costs and health utilities to calculate number needed to treat (NNT) to avoid any MVE, incremental costs and QALYs gained/ person for IA vs. RHI. A 3-year time horizon and German 3(rd)-party payer perspective were used. Probabilistic sensitivity analysis was performed, sampling from distributions of key parameters. Additional sensitivity analyses were performed.
  
  
  RESULTS
  NNT over a 3 year period to avoid any MVE was 8 patients for IA vs. RHI. Due to lower MVE rates, IA dominated RHI with 0.020 QALYs gained (95% confidence interval: 0.014-0.025) and cost savings of EUR 1 556 (1 062-2 076)/person for IA vs. RHI over the 3-year time horizon. Sensitivity analysis revealed that IA would still be overall cost saving even if the cost of IA was double the cost/unit of RHI.
  
  
  CONCLUSIONS
  From a health economics perspective, IA was the superior alternative for the insulin treatment of type 2 diabetes, with lower incidence of MVE events translating to improved QALYs and lower costs vs. RHI within a 3-year time horizon.
authors.affiliation: Centre for Diabetes and Metabolism, Fachklinik Bad Heilbrunn, Bad Heilbrunn, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Liebl
authors.affiliation: Novo Nordisk Pharma GmbH, Mainz.
authors.forename: L
authors.initials: L
authors.lastname: Seitz
authors.affiliation: Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, -Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Palmer
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D003365:Costs and Cost Analysis; D048909:Diabetes Complications / Q000188:drug therapy / Q000191:economics; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics; D005500:Follow-Up Studies; D058006:General Practice; D005858:Germany; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics; D061267:Insulin Aspart / Q000008:administration & dosage / Q000191:economics; D017059:Models, Econometric; D013997:Time Factors
chemical_list: D007004:Hypoglycemic Agents; D061267:Insulin Aspart