Modeling the lifetime costs of insulin glargine and insulin detemir in type 1 and type 2 diabetes patients in Canada: A meta-analysis and a cost-minimization analysis

Abstract

Background: Two basal insulin analogues, insulin glargine once daily and insulin detemir once or twice daily, are marketed in Canada. Objective: To estimate the long-term costs of insulin glargine once daily (QD) versus insulin detemir once or twice daily (QD or BID) for type 1 (T1DM) and type 2 (T2DM) diabetes mellitus from a Canadian provincial government's perspective. Methods: A cost-minimization analysis comparing insulin glargine (IGlarg) to insulin detemir (IDet) was conducted using a validated computer simulation model, the CORE Diabetes Model. Lifetime direct medical costs including costs of insulin treatment and diabetes complications were projected. T1DM and T2DM patients' daily insulin dose (T1DM: IGlarg QD 26.2IU; IDet BID 33.6IU; T2DM: IGlarg QD 47.2IU; IDet QD 65.7IU or IDet BID 80.4IU) was derived from a meta-analysis of randomized trials. All patients were assumed to stay on the same treatment for life. Costs were discounted at 5% per annum and reported in 2010 Canadian Dollars. Results: The meta-analysis showed T1DM and T2DM patients had similar HbA1c change from baseline when receiving IGlarg compared to IDet (T1DM: 0.002%-points; p=0.97; T2DM:-0.05%-points; p=0.28). Treatment of T1DM patients with IGlarg versus IDet BID resulted in lifetime cost savings of $4231 per patient. Treatment of T2DM patients with IGlarg resulted in lifetime cost savings of $4659 per patient versus IDet QD and cost savings of $8709 per patient versus IDet BID. Conclusions: Similar HbA1c change from baseline can be achieved with a lower IGlarg than IDet dose. From the perspective of a Canadian provincial government, treatment of T1DM and T2DM patients with IGlarg instead of IDet can generate long-term cost savings. Main limitations include trial data were derived from multi-country studies rather than the Canadian population and self-monitoring blood glucose costs were not included. © 2011 Informa UK Ltd.