Costs of antihyperglycemic treatment and consumables and treatment satisfaction in patients with type 2 diabetes: results of a cross-sectional cost evaluation study of long-acting Insulin glargine compared with NPH insulin in Germany (LIVE-DE)

Background: Economic aspects and patient-reported outcomes play an increasing role in the choice of therapeutic options. The aim of the LIVE-DE study (Long-acting insulin glargine versus NPH insulin cost evaluation in Germany[DE]) was to assess expenditures incurred in the care of diabetic patients, as well treatment satisfaction of patients with type 2 diabetes treated with insulin glargine (GLAR) or NPH insulin (NPH). Patients and methods: A retrospective, non-interventional, cross-sectional study was undertaken in Germany of 1,602 insulin-treated patients (982 on GLAR, 620 on NPH), enrolled from 199 randomly selected general practitioner or internal medicine specialist practices. Total cost of diabetes care (insulins, oral antidiabetic drugs, glucagon use, consumables for insulin administration and blood glucose self-monitoring devices) were calculated from total recorded expenditures, for a period of six months, from the perspective of statutory health insurance. Cost data were obtained from publicly available sources, based on the prices in the year 2007. Patient treatment satisfaction was assessed using previously validated questionnaires (SF-12, PAID, DTSQ, ITEQ). Results: Physicians prescribed GLAR more often than NPH combined with oral antidiabetic drugs (43% vs 16%), whereas NPH was more often used in an intensified insulin regimen compared to GLAR (79% vs 49%). The mean total costs per patient over six months were lower in GLAR than NPH treated patients (658 +/- 258 vs 685 +/- 242 Euros [(sic)]; p<0.001). The higher drug costs for basal insulin in the GLAR group (194 +/- 97 vs 116 +/- 74 (sic)) were counterbalanced by lower costs for bolus insulin (96 +/- 133 vs 158 +/- 133 (sic)), test strips (287 +/- 137 vs 321 +/- 142 (sic)) and needles (40 +/- 31 vs 46 +/- 40 (sic)). Only in the NPH group was glucagon use documented (in four patients). Patients treated with GLAR reported significantly higher treatment satisfaction. After adjustment of empirical results (by analysis of covariance), mean total costs of diabetes were higher in GLAR patients (+73.1 (sic); p<0.001). But treatment satisfaction remained significantly higher with GLAR. Conclusion: Based on the comparison of total diabetes treatment costs under real-life conditions between glargine and NPH insulin based treatment regimens, these results indicate that the choice of a given treatment should be determined by medical advantages and patients' preferences. Because of a lower injection rate and a higher patient treatment satisfaction, the use of glargine as first-line therapeutic approach is justified in order to achieve target glycemic control in insulin dependent type 2 diabetics.