Treating Type 1 Diabetes Mellitus with a Rapid-Acting Analog Insulin Regimen vs. Regular Human Insulin in Germany: A Long-Term Cost-Effectiveness Evaluation
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The aim of the present study was to evaluate the cost effectiveness of rapid-acting analog insulin relative to regular human insulin in adults with type 1 diabetes mellitus in Germany.
The PRIME Diabetes Model, a patient-level, discrete event simulation model, was used to project long-term clinical and cost outcomes for patients with type 1 diabetes from the perspective of a German healthcare payer. Simulated patients had a mean age of 21.5 years, duration of diabetes of 8.6 years, and baseline glycosylated hemoglobin of 7.39%. Regular human insulin and rapid-acting analog insulin regimens reduced glycosylated hemoglobin by 0.312 and 0.402%, respectively. Compared with human insulin, hypoglycemia rate ratios with rapid-acting analog insulin were 0.51 (non-severe nocturnal) and 0.80 (severe). No differences in non-severe diurnal hypoglycemia were modeled. Discount rates of 3% were applied to future costs and clinical benefits accrued over the 50-year time horizon.
In the base-case analysis, rapid-acting analog insulin was associated with an improvement in quality-adjusted life expectancy of 1.01 quality-adjusted life-years per patient (12.54 vs. 11.53 quality-adjusted life-years). Rapid-acting analog insulin was also associated with an increase in direct costs of €4490, resulting in an incremental cost-effectiveness ratio of €4427 per quality-adjusted life-year gained vs. human insulin. Sensitivity analyses showed that the base case was driven predominantly by differences in hypoglycemia; abolishing these differences reduced incremental quality-adjusted life expectancy to 0.07 quality-adjusted life-years, yielding an incremental cost-effectiveness ratio of €74,622 per quality-adjusted life-year gained.
Rapid-acting analog insulin is associated with beneficial outcomes in patients with type 1 diabetes and is likely to be considered cost effective in the German setting vs. regular human insulin.
KSB and KVB devised the research question. All authors were involved in devising the literature search strategy. WJV and RFP then ran the literature searches, screened the retrieved literature, and extracted the data used in the final analyses. All authors were subsequently involved in scrutinizing and, where necessary, revising the simulation plans for the final analyses. RFP ran the analyses in the PRIME Diabetes Model, which were cross-checked with the original data sources by WJV. RFP and WJV wrote the first draft of the manuscript, with KSB and KVB making substantive revisions prior to submission.
Compliance with Ethical Standards
The study was funded by Eli Lilly and Company.
Conflict of interest
Richard F. Pollock and William J. Valentine are full-time employees of Ossian Health Economics and Communications GmbH, which received consultancy fees from Eli Lilly and Company to conduct the analysis and for the preparation of the manuscript. Kristina S. Boye and Kate Van Brunt are full-time employees of Eli Lilly and Company, which manufactures the rapid-acting insulin Humalog (Insulin lispro) and other antidiabetic agents.
No patient-level data were used as part of the present study. As such, ethics approval and patient consent were neither required nor sought.
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