Cost comparison of insulin glargine and insulin detemir in type 2 diabetes mellitus in Argentina: a trial based probabilistic model

PICHON RIVIERE A; CAPORALE J; AUGUSTOVSKI, F; VON SCHULZ HAUSMANN; GAGIARDINO, J

VALUE IN HEALTH

WILEY-BLACKWELL PUBLISHING, INC

Lugar: Londres; Año: 2008 p. 1 - 6

1098-3015

OBJECTIVES: To estimate and compare the economic implications of insulin glargine (GLAR) and detemir (DET) therapy initiation in a population with type 2 diabetes mellitus (T2DM) with a one year time horizon, from major insurers perspectives in Argentina (union-based and private HMOs). METHODS: Clinical and efficacy parameters and their distributions were based on Rosenstock?s article (2008), a 52-week randomized treat-totarget trial which compared clinical outcomes following supplementation of oral glucose-lowering drugs with basal insulin analogues, DET and GLAR, in T2DM patients. Resource use and cost values, as well as their distributions, were obtained from Argentinean published literature, tariffs, databases, experts? opinion and the international literature. Costs are expressed in local currency, year 2008 (exchange rate 1? = 4.79ARG$). Variability was incorporated in insulin, needles and strips costs, proportion of DET patients with once daily injection and GLAR and DET dose per kilogram. Probabilistic sensitivity analysis (PSA) was carried out based on Monte Carlo simulations with 10,000 iterations. Linear regression analysis was carried out in order to gauge the relative influence on the results related to the uncertainty around each parameter. RESULTS: Annual mean cost was $2630 for GLAR and $4,092 for DET, implying a 36% (95%CI 33.2%; 37.9%) total cost saving with GLAR ($1462). A total of 82.7% of this difference was explained by the lower average daily dose requirement with GLAR (GLAR 26 UI vs. DET 42 UI). Savings in test strips, and needles explained 10.2% and 7.1% of the total difference. In the regression analysis, the most important parameters explaining variability in total cost savings were the proportion of DET patients requiring twice daily injections followed by the insulin dose per patient. CONCLUSIONS: In Argentina, Insulin Glargine was associated with a cost saving of more than one third compared to the use of Insulin Detemir. Sensitivity analyses confirmed the robustness of this result