title: An analysis of the cost-effectiveness of starting insulin detemir in insulin-naïve people with type 2 diabetes.
abstract: OBJECTIVE
  There is limited evidence with respect to the cost-effectiveness of starting insulin in people with diabetes outside the 'western' world. The aim of this study was to assess the cost-effectiveness of starting basal insulin treatment with insulin detemir in people with type 2 diabetes (T2D) inadequately controlled on oral glucose-lowering drugs (OGLDs) in Mexico, South Korea, India, Indonesia, and Algeria.
  
  
  METHODS
  The IMS CORE Diabetes Model was used to project clinical and cost outcomes over a 30-year time horizon. Clinical outcomes, baseline characteristics and health state utility data were taken from the A1chieve study. A 1-year analysis was also conducted based on treatment costs and quality-of-life data. Incremental cost-effectiveness ratios (ICERs) were expressed as a fraction of GDP per capita, and WHO-CHOICE recommendations (ICER < 3.0) used to define cost-effectiveness.
  
  
  RESULTS
  Starting insulin detemir was associated with a projected increase in life expectancy (≥1 year) and was considered cost-effective in all of the studied populations with ICERs of -0.02 (Mexico), 0.00 (South Korea), 0.48 (India), 0.12 (Indonesia), and 0.88 (Algeria) GDP/quality-adjusted life-year. Cost-effectiveness was maintained after conducting sensitivity analyses in the 30-year and 1-year analyses. A projected increase in treatment costs was partially offset by a reduction in complications. The difference in overall costs between insulin detemir and OGLDs alone was USD518, 1431, 3510, 15, and 5219, respectively.
  
  
  CONCLUSIONS
  Changes in clinical outcomes associated with starting insulin detemir in insulin-naïve individuals with T2D resulted in health gains that made the intervention cost-effective in five countries with distinct healthcare resources.
authors.affiliation: The Medical School, Newcastle University , Newcastle upon Tyne , UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Home
authors.forename: Sei Hyun
authors.initials: SH
authors.lastname: Baik
authors.forename: Guillermo González
authors.initials: GG
authors.lastname: Gálvez
authors.forename: Rachid
authors.initials: R
authors.lastname: Malek
authors.forename: Annie
authors.initials: A
authors.lastname: Nikolajsen
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin; D059066:Gross Domestic Product; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D000069057:Insulin Detemir / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D008017:Life Expectancy; D008297:Male; D008800:Mexico; D008875:Middle Aged; D017059:Models, Econometric; D019057:Quality-Adjusted Life Years
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069057:Insulin Detemir
keywords: A1chieve; Cost-effectiveness; Insulin detemir; Type 2 diabetes