title: [Comparative analysis of insulin glargine vs. insulin detemir: A cost-minimization study applicable to Colombia].
abstract: BACKGROUND
  More than 90% of subjects diagnosed with diabetes mellitus present with type 2, which is recognized for peripheral insulin resistance.
  
  
  OBJECTIVE
  To determine the costs of achieving glycemic target with the use of basal insulin analogs, insulin glargine (IG) once a day vs. insulin detemir (ID) once or twice a day, with a cost minimization model built from a third-party payer perspective in Colombia.
  
  
  METHODS
  A systematic review of comparative clinical trials between IG and ID in patients with insulin-resistant type 2 diabetes was performed to determine data of use, effectiveness and frequency of and adverse events. The goal of glycemic control (effectiveness measure) was defined as HbA1c=7%. The costs of insulin were extracted from the Integrated System of Medication Prices 2012 (Ministerio de Salud y Protección Social de Colombia) and the IMS Consulting Group mobile average cost for the past year as of December, 2012. Sensitivity analyses were performed via Montecarlo simulations for dose and medication costs (insulin).
  
  
  RESULTS
  Five publications met inclusion criteria. The range of the difference between insulin doses was 3.2 IU to 33 IU. The percentage of patients requiring two ID doses was 12.6-100%. There were no significant differences in hypoglycemic events. For both retail and institutional channels, there was a higher differential cost between IG vs. ID favoring IG in 4 and 5 studies, respectively. For the retail channel only one study showed the opposite results.
  
  
  CONCLUSIONS
  As only medication costs are considered, differences in insulin units between IG and ID result in a differential cost in favor of IG that makes it a cost/effective alternative.
authors.affiliation: Escuela de Medicina, Universidad El Bosque, Bogotá, D.C, Colombia.
authors.forename: Argemiro
authors.initials: A
authors.lastname: Fragozo
authors.affiliation: Sanofi-Aventis de Colombia, S. A, Bogotá, D.C, Colombia.
authors.forename: María Fernanda
authors.initials: MF
authors.lastname: Puerta
authors.affiliation: Sanofi-Aventis de Colombia, S. A, Bogotá, D.C, Colombia.
authors.forename: Juan Diego
authors.initials: JD
authors.lastname: Misas
mesh_terms: D003105:Colombia; D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D016527:Drug Costs / Q000706:statistics & numerical data*; D006801:Humans; D000069057:Insulin Detemir / Q000191:economics* / Q000627:therapeutic use*; D000069036:Insulin Glargine / Q000191:economics* / Q000627:therapeutic use*; D018803:Models, Economic
chemical_list: D000069036:Insulin Glargine; D000069057:Insulin Detemir