title: Is the current standard of care leading to cost-effective outcomes for patients with type 2 diabetes requiring insulin? A long-term health economic analysis for the UK.
abstract: OBJECTIVE
  The aim of the analysis was to investigate whether insulin intensification, based on the use of intensive insulin regimens as recommended by the current standard of care in routine clinical practice, would be cost-effective for patients with type 2 diabetes in the UK.
  
  
  METHODS
  Clinical data were derived from a retrospective analysis of 3185 patients with type 2 diabetes on basal insulin in The Health Improvement Network (THIN) general practice database. In total, 48% (614 patients) intensified insulin therapy, defined by adding bolus or premix insulin to a basal regimen, which was associated with a reduction in HbA1c and an increase in body mass index. Projections of clinical outcomes and costs (2011 GBP) over patients' lifetimes were made using a recently validated type 2 diabetes model.
  
  
  RESULTS
  Immediate insulin intensification was associated with improvements in life expectancy, quality-adjusted life expectancy and time to onset of complications versus no intensification or delaying intensification by 2, 4, 6, or 8 years. Direct costs were higher with the insulin intensification strategy (due to the acquisition costs of insulin). Incremental cost-effectiveness ratios for insulin intensification were GBP 32,560, GBP 35,187, GBP 40,006, GBP 48,187 and GBP 55,431 per QALY gained versus delaying intensification 2, 4, 6 and 8 years, and no intensification, respectively.
  
  
  CONCLUSIONS
  Although associated with improved clinical outcomes, insulin intensification as practiced in the UK has a relatively high cost per QALY and may not lead to cost-effective outcomes for patients with type 2 diabetes as currently defined by UK cost-effectiveness thresholds.
authors.affiliation: Ossian Health Economics and Communications, Basel, Switzerland. Electronic address: valentine@ossianconsulting.com.
authors.forename: W J
authors.initials: WJ
authors.lastname: Valentine
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: B H
authors.initials: BH
authors.lastname: Curtis
authors.affiliation: Ossian Health Economics and Communications, Basel, Switzerland.
authors.forename: R F
authors.initials: RF
authors.lastname: Pollock
authors.affiliation: Lilly Research Center, Windlesham, Surrey, UK.
authors.forename: K
authors.initials: K
authors.lastname: Van Brunt
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: R
authors.initials: R
authors.lastname: Paczkowski
authors.affiliation: Division of Endocrinology and Diabetes, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Brändle
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Boye
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Kendall
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000191:economics*; D007328:Insulin / Q000008:administration & dosage* / Q000191:economics*; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D059039:Standard of Care / Q000191:economics*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Cost; Cost-effectiveness; Insulin; Type 2 diabetes; UK