title: Systematic Review of the Cost Effectiveness of Insulin Analogues in Type 1 and Type 2 Diabetes Mellitus.
abstract: Insulin analogues have a pharmacokinetic advantage over human insulin and are increasingly used to treat diabetes mellitus. A summary of their cost effectiveness versus other available treatments was required.
  
  
  
  Our objective was to systematically review the published cost-effectiveness studies of insulin analogues for the treatment of patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).
  
  
  
  We searched major databases and health technology assessment agency reports for economic evaluation studies published up until 30 September 2015. Two reviewers performed data extraction and assessed the quality of the data using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines.
  
  
  
  Seven of the included studies assessed short-acting insulin analogues, 12 assessed biphasic insulin analogues, 30 assessed long-acting insulin analogues and one assessed a combination of short- and long-acting insulin analogues. Only 17 studies involved patients with T1DM, all were modelling studies and 12 were conducted in Canada. The incremental cost-effectiveness ratios (ICERs) for short-acting insulin analogues ranged from dominant to $US435,913 per quality-adjusted life-year (QALY) gained, the ICERs for biphasic insulin analogues ranged from dominant to $US57,636 per QALY gained and the ICERs for long-acting insulin analogues ranged from dominant to $US599,863 per QALY gained. A total of 15 studies met all the CHEERS guidelines reporting quality criteria. Only 26 % of the studies assessed heterogeneity in their analyses.
  
  
  
  Current evidence indicates that insulin analogues are cost effective for T1DM; however, evidence for their use in T2DM is not convincing. Additional evidence regarding compliance and efficacy is required to support the broader use of long-acting and biphasic insulin analogues in T2DM. The value of insulin analogues depends strongly on reductions in hypoglycaemia event rates and its efficacy in lowering glycated haemoglobin (HbA1c).
authors.affiliation: Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), 11800, Penang, Malaysia. aakmal@usm.my.
authors.forename: Asrul Akmal
authors.initials: AA
authors.lastname: Shafie
authors.affiliation: Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), 11800, Penang, Malaysia.
authors.forename: Chin Hui
authors.initials: CH
authors.lastname: Ng
authors.affiliation: Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), 11800, Penang, Malaysia.
authors.forename: Yui Ping
authors.initials: YP
authors.lastname: Tan
authors.affiliation: School of Pharmacy, Monash University Malaysia, Selangor, Malaysia.|Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research (CPOR), Naresuan University, Phitsanulok, Thailand.|School of Pharmacy, University of Wisconsin, Madison, WI, USA.|School of Population Health, University of Queensland, Brisbane, QLD, Australia.
authors.forename: Nathorn
authors.initials: N
authors.lastname: Chaiyakunapruk
mesh_terms: D002170:Canada; D003362:Cost-Benefit Analysis; D003692:Delayed-Action Preparations; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000191:economics; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics; D061385:Insulins / Q000008:administration & dosage* / Q000191:economics; D019057:Quality-Adjusted Life Years
chemical_list: D003692:Delayed-Action Preparations; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D061385:Insulins