Evaluation of the cost-effectiveness of insulin glargine versus NPH insulin for the treatment of type 2 diabetes in the UK

Background: People with type 2 diabetes typically require insulin treatment following failure on hypoglycaemic agents. The purpose of this study was to evaluate the relative cost-effectiveness of insulin glargine versus NPH insulin for the treatment of type 2 diabetes in the UK. Insulin glargine has been shown to reduce the likelihood of hypoglycaemia and improve HbA(1c) in type 2 diabetes by comparison with NPH insulin. Methods: The study used a discrete event simulation model designed to forecast the costs and health outcome of a cohort of 1000 subjects over 40 years. The two main scenarios involved a difference in the likelihood of hypoglycaemia or a difference in HbA(1c). Prices were in UK pound 2005 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 was 210 027 per quality adjusted life year under a differential hypoglycaemia-only scenario. The incremental cost-effectiveness ratio of insulin glargine versus NPH insulin was El 3 921 per quality adjusted life year under a differential HbA(1c)-only scenario. In wide-ranging sensitivity analysis, the ICER was consistently below 20000 pound per quality adjusted life year gained. Conclusion: This study was 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 2 diabetes in the UK. per year. Effectiveness data were pooled data from randomised clinical trials. Results: The incremental cost-effectiveness ratio of insulin glargine versus NPH insulin was 10027 pound per quality adjusted life year under a differential hypoglycaemia-only scenario. The incremental cost-effectiveness ratio of insulin glargine versus NPH insulin was 13921 pound per quality adjusted life year under a differential HbA(1c)-only scenario. In wide-ranging sensitivity analysis, the ICER was consistently below 20000 pound per quality adjusted life year gained. Conclusion: This study was 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 2 diabetes in the UK.