Short-term cost-effectiveness of insulin detemir and insulin aspart in people with type 1 diabetes who are prone to recurrent severe hypoglycemia.
OBJECTIVE
Based on the data of the HypoAna trial (ClinicalTrials.gov NCT00346996), a short-term cost-effectiveness analysis was conducted comparing an all insulin analogue regimen with an all human insulin regimen in people with type 1 diabetes who are prone to recurrent severe hypoglycemia.


METHODS
Clinical data from the HypoAna trial and Danish cost data related to the treatment of severe hypoglycemia were used to populate a 1-year cost-effectiveness analysis. Hypoglycemia quality-of-life data were based on previously published utility values, used to calculate the quality-adjusted life-years (QALYs) gained. Sensitivity analyses were conducted to test the robustness of the analysis. The main outcome measure was the incremental cost-effectiveness ratio (ICER).


RESULTS
The insulin analogue regimen was associated with greater total costs compared with the human insulin regimen (20,418 DKK [1972 GBP] vs. 18,558 DKK [1793 GBP], respectively), primarily driven by the difference in insulin costs. Total costs for corrective actions for hypoglycemic events, however, were lower in the insulin analogue group (927 DKK [89 GBP]) compared with the human insulin group (1311 DKK [127 GBP]), primarily due to a lower event rate. QALYs were higher with insulin analogues vs. human insulin (difference 0.0672). The resulting ICER was 27,685 DKK (2674 GBP) per QALY gained, which is well below the generally accepted cost-effectiveness threshold.


CONCLUSIONS
The analysis shows that treating people with type 1 diabetes who are prone to recurrent severe hypoglycemia with an insulin analogue regimen is cost-effective compared with a human insulin regimen.
a Department of Cardiology, Nephrology and Endocrinology , Nordsjællands University Hospital-Hillerød , Hillerød , Denmark.|b Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark.
Ulrik
U
Pedersen-Bjergaard
a Department of Cardiology, Nephrology and Endocrinology , Nordsjællands University Hospital-Hillerød , Hillerød , Denmark.
Peter Lommer
PL
Kristensen
c Department of Endocrinology , Hvidovre University Hospital , Hvidovre , Denmark.
Kirsten
K
Nørgaard
d Department of Endocrinology and Gastroenterology , Bispebjerg University Hospital , Copenhagen , Denmark.
Hans
H
Perrild
e Department of Endocrinology , Copenhagen University Hospital (Rigshospitalet) , Copenhagen , Denmark.
Tonny
T
Jensen
a Department of Cardiology, Nephrology and Endocrinology , Nordsjællands University Hospital-Hillerød , Hillerød , Denmark.|b Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark.
Birger
B
Thorsteinsson
f Market Access, Novo Nordisk A/S , Søborg , Denmark.
Annie
A
Nikolajsen
g Department of Clinical Medicine - Department of Clinical Epidemiology , University of Aarhus , Aarhus , Denmark.|h Clinical Research Unit, Steno Diabetes Center , Gentofte , Denmark.|i Department of Clinical Research , Nordsjællands University Hospital-Hillerød , Hillerød , Denmark.
Lise
L
Tarnow
Cost analysis; Diabetes complications; Hypoglycemia; Insulin; Type 1 diabetes mellitus