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Long-Term Cost-Effectiveness of Insulin Glargine Versus Neutral Protamine Hagedorn Insulin for Type 2 Diabetes in Thailand

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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.

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Acknowledgments

This study was supported by Grants from the Subcommittees of the National List of Essential Medicine, Thailand. The authors gratefully acknowledge the support of the National Drug Selection Working Group in Endocrinology for their valuable comment on this study, and the IMS Health team for supporting the IMS CORE Diabetes Model.

Authors’ contributions

Unchalee Permsuwan designed the study; gathered the information for input parameters; ran the CDM; interpreted study findings; and prepared, edited, and approved the manuscript. Nathorn Chaiyakunapruk designed and conducted the study, interpreted the study results, and approved the final manuscript. Piyameth Dilokthornsakul and Surasak Saokaew were involved in the hospital database analyses, literature search for input parameters, and manuscript preparation and approval. Kednapa Thavorn performed the literature search for input parameters, developed a budget impact model, and prepared and approved the manuscript.

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Authors and Affiliations

  1. Faculty of Pharmacy, Chiang Mai University, Suthep Road, Muang District, Chiang Mai, 50200, Thailand

    Unchalee Permsuwan

  2. School of Pharmacy, Monash University Malaysia, Selangor, Malaysia

    Nathorn Chaiyakunapruk

  3. Center of Pharmaceutical Outcomes Research (CPOR), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand

    Nathorn Chaiyakunapruk, Piyameth Dilokthornsakul & Surasak Saokaew

  4. School of Population Health, University of Queensland, Brisbane, Australia

    Nathorn Chaiyakunapruk

  5. School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA

    Nathorn Chaiyakunapruk

  6. Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada

    Kednapa Thavorn

  7. Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada

    Kednapa Thavorn

  8. Institute of Clinical and Evaluative Sciences, Toronto, ON, Canada

    Kednapa Thavorn

  9. School of Pharmaceutical Sciences, Center of Health Outcomes Research and Therapeutic Safety (COHORTS), University of Phayao, Phayao, Thailand

    Surasak Saokaew

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  1. Unchalee Permsuwan
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Correspondence to Unchalee Permsuwan.

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Unchalee Permsuwan, Nathorn Chaiyakunapruk, Piyameth Dilokthornsakul, Kednapa Thavorn, and Surasak Saokaew declare no conflicts of interest.

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Permsuwan, U., Chaiyakunapruk, N., Dilokthornsakul, P. et al. Long-Term Cost-Effectiveness of Insulin Glargine Versus Neutral Protamine Hagedorn Insulin for Type 2 Diabetes in Thailand. Appl Health Econ Health Policy 14, 281–292 (2016). https://doi.org/10.1007/s40258-016-0228-3

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