Cost-effectiveness of biphasic insulin aspart 30 vs. human premix insulin in type 2 diabetes from the payer's perspective in Bulgaria

The aim of this study was to assess the long-term cost-effectiveness of biphasic insulin aspart 30 versus human premix insulin in patients with type 2 diabetes from a third-party payer perspective in a Bulgarian setting. The extensively published and validated CORE Diabetes Model was populated with the clinical data from the IMPROVETM observational study for the subgroup of patients previously receiving human premix insulin. In the base-case analysis a time horizon of 30 years was chosen to reflect all the relevant long-term costs and outcomes of diabetes. The analysis used health state utility values derived from the literature. The unit costs of treatment and complications were obtained from published sources, expert opinion survey and official tariff lists for healthcare services (1 BGN = 0.51 EUR). Biphasic insulin aspart 30 was projected to improve quality-adjusted life expectancy by 0.67 QALYs compared to human premix insulin (6.22 ± 0.11 versus 5.55 ± 0.10). Direct costs with biphasic insulin aspart decreased by BGN 1 703 (BGN 15 708 ± 412 versus BGN 17 412 ± 463) per patient from a third-party payer perspective. Biphasic insulin aspart 30 was shown to be more effective and less costly from a third-party payer perspective than human premix insulin for type 2 diabetes in Bulgaria, and may be considered dominant.