Health economic evaluations comparing insulin glargine with NPH insulin in patients with type 1 diabetes: A systematic review

被引：7
作者：
Hagenmeyer E.-G. [1 ]
Koltermann K.C. [2 ]
Dippel F.-W. [3 ]
Schädlich P.K. [4 ]
机构：
[1] 10245 Berlin
[2] 10437 Berlin
[3] Sanofi-Aventis Deutschland GmbH, 10785 Berlin
[4] IGES Institut GmbH, 10117 Berlin
来源：
Cost Effectiveness and Resource Allocation | / 9卷 / 1期
关键词：
Basal-bolus therapy; Health economics; Insulin glargine; Nph; Systematic review; Type; 1; diabetes;
D O I：
10.1186/1478-7547-9-15
中图分类号：
学科分类号：
摘要：
Background: Compared to conventional human basal insulin (neutral protamine Hagedorn; NPH) the long-acting analogue insulin glargine (GLA) is associated with a number of advantages regarding metabolic control, hypoglycaemic events and convenience. However, the unit costs of GLA exceed those of NPH. This study aims to systematically review the economic evidence comparing GLA with NPH in basal-bolus treatment (intensified conventional therapy; ICT) of type 1 diabetes in order to facilitate informed decision making in clinical practice and health policy.Methods: A systematic literature search was performed for the period of January 1st 2000 to December 1st 2009 via Embase, Medline, the Cochrane Library, the databases GMS (German Medical Science) and DAHTA (Deutsche Agentur für Health Technology Assessment), and the abstract books of relevant international scientific congresses. Retrieved studies were reviewed based on predefined inclusion criteria, methodological and quality aspects. In order to allow comparison between studies, currencies were converted using purchasing power parities (PPP).Results: A total of 7 health economic evaluations from 4 different countries fulfilled the predefined criteria: 6 modelling studies, all of them cost-utility analyses, and one claims data analysis with a cost-minimisation design. One cost-utility analysis showed dominance of GLA over NPH. The other 5 cost-utility analyses resulted in additional costs per quality adjusted life year (QALY) gained for GLA, ranging from € 3,859 to € 57,002 (incremental cost effectiveness ratio; ICER). The cost-minimisation analysis revealed lower annual diabetes-specific costs in favour of NPH from the perspective of the German Statutory Health Insurance (SHI).Conclusions: The incremental cost-utility-ratios (ICER) show favourable values for GLA with considerable variation. If a willingness-to-pay threshold of £ 30,000 (National Institute of Clinical Excellence, UK) is adopted, GLA is cost-effective in 4 of 6 cost utility analyses (CUA) included. Thus insulin glargine (GLA) seems to offer good value for money. Comparability between studies is limited because of methodological and country specific aspects. The results of this review underline that evaluation of insulin therapy should use evidence on efficacy of therapy from information synthesis. The concept of relating utility decrements to fear of hypoglycaemia is a plausible approach but needs further investigation. Also future evaluations of basal-bolus insulin therapy should include costs of consumables such as needles for insulin injection as well as test strips and lancets for blood glucose self monitoring. © 2011 Hagenmeyer et al; licensee BioMed Central Ltd.
引用
收藏
相关论文
共 41 条
[1]  
Hirsch I.B., Drug therapy: insulin analogues, N Engl J Med Vol 352, 2, pp. 174-183, (2005)
[2]  
Owens D.R., Bolli G.B., Beyond the era of NPH insulin--long-acting insulin analogs: chemistry, comparative pharmacology, and clinical application, Diabetes Technol Ther, 10, 5, pp. 333-349, (2008)
[3]  
Heinemann L., Linkeschova R., Rave K., Hompesch B., Sedlak M., Heise T., Time action profile of the long acting insulin analog isnulin glargine (HOE901) in comparison with those of NPH insulin anf placebo, Diabetes Care, 23, pp. 644-649, (2000)
[4]  
Monami M., Marchionni N., Mannucci E., Long-acting insulin analogues vs. NPH human insulin in type 1 diabetes. A meta-analysis, Diabetes Obes Metab, 11, 4, pp. 372-378, (2009)
[5]  
Singh S.R., Ahmad F., Lal A., Yu C., Bai Z., Bennett H., Efficacy and safety of insulin analogues for the management of diabetes mellitus: a meta-analysis, CMAJ, 180, 4, pp. 385-397, (2009)
[6]  
Vardi M., Jacobson E., Nini A., Bitterman H., Intermediate acting versus long acting insulin for type 1 diabetes mellitus, Cochrane Database Syst Rev, 3, (2008)
[7]  
Mullins P., Sharplin P., Yki-Jarvinen H., Riddle M.C., Haring H.U., Negative binomial meta-regression analysis of combined glycosylated hemoglobin and hypoglycemia outcomes across eleven Phase III and IV studies of insulin glargine compared with neutral protamine Hagedorn insulin in type 1 and type 2 diabetes mellitus, Clin Ther, 29, 8, pp. 1607-1619, (2007)
[8]  
Patterson C.C., Dahlquist G.G., Gyurus E., Green A., Soltesz G., Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20: a multicentre prospective registration study, Lancet, 373, 9680, pp. 2027-2033, (2009)
[9]  
Liberati A., Altman D.G., Tetzlaff J., Mulrow C., Gotzsche P.C., Ioannidis J.P., Clarke M., Devereaux P.J., Kleijnen J., Moher D., The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration, BMJ, 339, (2009)
[10]  
Higgins J.P.T., Green S., Cochrane Handbook for Systematic Reviews of Interventions, (2008)
12345