Direct costs associated with initiating NPH insulin versus glargine in patients with type 2 diabetes: A retrospective database analysis

Aims: To compare total costs and risk of hypoglycemia in patients with type 2 diabetes (T2D) initiated on NPH insulin versus glargine in a real-world setting. Methods: This study used claims data (10/2001 to 06/2005) from a privately insured U.S. population of adult T2D patients who were initiated on NPH or glargine following a 6-month insulin-free period. A sample of 1698 glargine-treated and 400 NPH-treated patients met the inclusion criteria. Total and diabetes-related costs (inflation-adjusted to 2006) were calculated for 6-month pre- and post-index periods and compared between 400 patient pairs matched by a propensity score method. Results: In the post-index 6-month period, glargine patients incurred higher diabetes-related drug costs than NPH patients ($785 versus $632, p < 0.0001) but there were no significant differences in diabetes-related medical or total costs, or all other total cost categories. Compared to the pre-index period, glargine patient costs declined by $2420 (p = 0.058) whereas NPH patient costs declined by $4200 (p = 0.046), with no statistically significant group differences (p = 0.469). Among patients with hypoglycemia-related claims (0.75% in both groups), mean hypoglycemia-related costs were $85 and $202 for NPH and glargine patients, respectively (p = 0.564). Conclusion: initiation of either NPH or glargine was associated with major cost reductions and infrequent hypoglycemia -related claims. (C) 2009 Elsevier Ireland Ltd. All rights reserved.