title: A cost comparison of long-acting insulin analogs vs NPH insulin-based treatment in patients with type 2 diabetes using routinely collected primary care data from the UK.
abstract: OBJECTIVE
  The aim of this analysis was to investigate total healthcare costs, HbA1c, and weight changes over a 36-month period in patients with type 2 diabetes initiated on NPH or long-acting insulin analogs.
  
  
  METHODS
  Electronic patient data from 479 general practices in the UK (THIN database) were examined for new users of glargine (n = 794), detemir (n = 252), or NPH insulin (n = 430). Annualized healthcare costs and clinical outcomes in years 1, 2, and 3 following insulin initiation were quantified and compared with baseline, using ANOVA and linear regression models.
  
  
  RESULTS
  A significant difference (p < 0.05) in total healthcare costs increases at year 1 vs baseline was observed between glargine and detemir, detemir and NPH, but not between glargine and NPH (increase: +£486, +£635, and +£420 for glargine, detemir, and NPH users, respectively). However, increases by year 3 were not significantly different between the insulins. A propensity score analysis comparing analog and NPH insulin showed that, following insulin initiation, increases in costs were higher with insulin analogs at year one (+£220), but this difference decreased over time in each year following insulin initiation (+£168 and +£146, respectively, for years 2 and 3). HbA1c reductions were not significantly different between the groups at all time points. Differences in weight gain between glargine and NPH were statistically significant at year 1 (0.87 kg vs 1.11 kg) and year 3 (1.15 kg vs 1.57 kg), but other estimates of between-group differences in weight gain were non-significant.
  
  
  CONCLUSIONS
  Following insulin initiation, the difference in healthcare costs of long-acting analogs compared to NPH insulin was transient. By year 3, the cost differences were not significantly different between the two cohorts, driven by an observed reduction in the cost of self-monitoring of blood glucose (SMBG) in the analog group and an increase in the cost of bolus insulin in the NPH group.
authors.affiliation: Division of Medical Sciences & Graduate Entry Medicine, University of Nottingham , Derby , UK.
authors.forename: Iskandar
authors.initials: I
authors.lastname: Idris
authors.forename: Jason
authors.initials: J
authors.lastname: Gordon
authors.forename: Carl
authors.initials: C
authors.lastname: Tilling
authors.forename: Jiten
authors.initials: J
authors.lastname: Vora
mesh_terms: D015992:Body Mass Index; D001835:Body Weight / Q000187:drug effects; D015897:Comorbidity; D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics*; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D000069036:Insulin Glargine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D007336:Insulin, Isophane / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D049528:Insulin, Long-Acting / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000191:economics* / Q000706:statistics & numerical data; D057216:Propensity Score; D006113:United Kingdom
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069036:Insulin Glargine; D007336:Insulin, Isophane; D049528:Insulin, Long-Acting; C517652:hemoglobin A1c protein, human
keywords: Diabetes; Insulin; Obesity; Vascular