title: Long-Term Cost-Effectiveness of Insulin Glargine Versus Neutral Protamine Hagedorn Insulin for Type 2 Diabetes in Thailand.
abstract: BACKGROUND
  Even though Insulin glargine (IGlar) has been available and used in other countries for more than a decade, it has not been adopted into Thai national formulary. This study aimed to evaluate the long-term cost effectiveness of IGlar versus neutral protamine Hagedorn (NPH) insulin in type 2 diabetes from the perspective of Thai Health Care System.
  
  
  METHODS
  A validated computer simulation model (the IMS CORE Diabetes Model) was used to estimate the long-term projection of costs and clinical outcomes. The model was populated with published characteristics of Thai patients with type 2 diabetes. Baseline risk factors were obtained from Thai cohort studies, while relative risk reduction was derived from a meta-analysis study conducted by the Canadian Agency for Drugs and Technology in Health. Only direct costs were taken into account. Costs of diabetes management and complications were obtained from hospital databases in Thailand. Both costs and outcomes were discounted at 3 % per annum and presented in US dollars in terms of 2014 dollar value. Incremental cost-effectiveness ratio (ICER) was calculated. One-way and probabilistic sensitivity analyses were also performed.
  
  
  RESULTS
  IGlar is associated with a slight gain in quality-adjusted life years (0.488 QALYs), an additional life expectancy (0.677 life years), and an incremental cost of THB119,543 (US$3522.19) compared with NPH insulin. The ICERs were THB244,915/QALY (US$7216.12/QALY) and THB176,525/life-year gained (LYG) (US$5201.09/LYG). The ICER was sensitive to discount rates and IGlar cost. At the acceptable willingness to pay of THB160,000/QALY (US$4714.20/QALY), the probability that IGlar was cost effective was less than 20 %.
  
  
  CONCLUSIONS
  Compared to treatment with NPH insulin, treatment with IGlar in type 2 diabetes patients who had uncontrolled blood glucose with oral anti-diabetic drugs did not represent good value for money at the acceptable threshold in Thailand.
authors.affiliation: Faculty of Pharmacy, Chiang Mai University, Suthep Road, Muang District, Chiang Mai, 50200, Thailand. unchalee.permsuwan@gmail.com.
authors.forename: Unchalee
authors.initials: U
authors.lastname: Permsuwan
authors.affiliation: School of Pharmacy, Monash University Malaysia, Selangor, Malaysia.|Center of Pharmaceutical Outcomes Research (CPOR), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.|School of Population Health, University of Queensland, Brisbane, Australia.|School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Nathorn
authors.initials: N
authors.lastname: Chaiyakunapruk
authors.affiliation: Center of Pharmaceutical Outcomes Research (CPOR), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
authors.forename: Piyameth
authors.initials: P
authors.lastname: Dilokthornsakul
authors.affiliation: Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.|Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.|Institute of Clinical and Evaluative Sciences, Toronto, ON, Canada.
authors.forename: Kednapa
authors.initials: K
authors.lastname: Thavorn
authors.affiliation: Center of Pharmaceutical Outcomes Research (CPOR), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.|School of Pharmaceutical Sciences, Center of Health Outcomes Research and Therapeutic Safety (COHORTS), University of Phayao, Phayao, Thailand.
authors.forename: Surasak
authors.initials: S
authors.lastname: Saokaew
mesh_terms: D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D048909:Diabetes Complications / Q000191:economics* / Q000401:mortality / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D000069036:Insulin Glargine / Q000191:economics* / Q000627:therapeutic use; D007336:Insulin, Isophane / Q000191:economics* / Q000627:therapeutic use; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D010602:Pharmacopoeias as Topic / Q000592:standards; D019057:Quality-Adjusted Life Years; D013785:Thailand / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D000069036:Insulin Glargine; D007336:Insulin, Isophane