Evaluation of the cost-effectiveness of insulin glargine versus NPH insulin for the treatment of type 1 diabetes in the UK

Background: The pivotal clinical trials programme used to evaluate insulin glargine for regulatory purposes primarily compared this new basal analogue insulin with neutral prolamine Hagedorn (NPH) insulin. The purpose of this study was to evaluate the relative cost-effectiveness of insulin glargine versus NPH insulin in the UK. Methods: The study used a discrete event simulation model designed to forecast the costs and health outcome of a cohort of 10 000 subjects over 40 years. The two main scenarios involved a difference in the likelihood of a hypoglycaemic event or a difference in HbA(1c). Prices were in UK 2005 pound costs. Costs and benefits were discounted at 3.5% per year. Effectiveness data were pooled data from randomised clinical trials. Results. The incremental cost-effectiveness ratio of insulin glargine versus NPH insulin ranged from 2695 pound to 10943 pound dependent upon the base-case scenario considered. Within a wide-ranging sensitivity analysis, the incremental cost-effectiveness ratio (ICER) was consistently below 20000 pound per quality-adjusted life year (QALY) gained. Conclusion: This study was one of the first to evaluate the relative cost-effectiveness of insulin glargine versus NPH insulin. Insulin glargine resulted in significant health benefits and represents excellent value for money for the treatment of type 1 diabetes.