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Systematic Review of the Cost Effectiveness of Insulin Analogues in Type 1 and Type 2 Diabetes Mellitus

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Abstract

Background

Insulin analogues have a pharmacokinetic advantage over human insulin and are increasingly used to treat diabetes mellitus. A summary of their cost effectiveness versus other available treatments was required.

Objective

Our objective was to systematically review the published cost-effectiveness studies of insulin analogues for the treatment of patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).

Methods

We searched major databases and health technology assessment agency reports for economic evaluation studies published up until 30 September 2015. Two reviewers performed data extraction and assessed the quality of the data using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines.

Results

Seven of the included studies assessed short-acting insulin analogues, 12 assessed biphasic insulin analogues, 30 assessed long-acting insulin analogues and one assessed a combination of short- and long-acting insulin analogues. Only 17 studies involved patients with T1DM, all were modelling studies and 12 were conducted in Canada. The incremental cost-effectiveness ratios (ICERs) for short-acting insulin analogues ranged from dominant to $US435,913 per quality-adjusted life-year (QALY) gained, the ICERs for biphasic insulin analogues ranged from dominant to $US57,636 per QALY gained and the ICERs for long-acting insulin analogues ranged from dominant to $US599,863 per QALY gained. A total of 15 studies met all the CHEERS guidelines reporting quality criteria. Only 26 % of the studies assessed heterogeneity in their analyses.

Conclusion

Current evidence indicates that insulin analogues are cost effective for T1DM; however, evidence for their use in T2DM is not convincing. Additional evidence regarding compliance and efficacy is required to support the broader use of long-acting and biphasic insulin analogues in T2DM. The value of insulin analogues depends strongly on reductions in hypoglycaemia event rates and its efficacy in lowering glycated haemoglobin (HbA1c).

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Acknowledgments

All authors were involved in the conception and design of this work and approved the final manuscript. Y. P. Tan and C. H. Ng acted as independent reviewers of the literature and were also responsible for study abstraction. C. H. Ng and A. A. Shafie wrote the manuscript. A. A. Shafie and N. Chaiyakunapruk supervised all study activities and were responsible for the final manuscript review. A. A. Shafie is the overall guarantor for this article.

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Authors and Affiliations

  1. Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), 11800, Penang, Malaysia

    Asrul Akmal Shafie, Chin Hui Ng & Yui Ping Tan

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

    Nathorn Chaiyakunapruk

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

    Nathorn Chaiyakunapruk

  4. School of Pharmacy, University of Wisconsin, Madison, WI, USA

    Nathorn Chaiyakunapruk

  5. School of Population Health, University of Queensland, Brisbane, QLD, Australia

    Nathorn Chaiyakunapruk

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  1. Asrul Akmal Shafie
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Asrul A. Shafie has previously provided writing assistance to Novo Nordisk. However, this review did not receive any sponsorship from Novo Nordisk. N. Chaiyakunapruk, C. H. Ng and Y. P. Tan have no conflicts of interest.

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Shafie, A.A., Ng, C.H., Tan, Y.P. et al. Systematic Review of the Cost Effectiveness of Insulin Analogues in Type 1 and Type 2 Diabetes Mellitus. PharmacoEconomics 35, 141–162 (2017). https://doi.org/10.1007/s40273-016-0456-2

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