Glyburide compared to insulin for the treatment of gestational diabetes mellitus: A cost analysis

Objective: To compare the costs associated with glyburide compared to insulin for the treatment of gestational diabetes unresponsive to dietary therapy. Study Design: A cost model was designed. The model excluded costs that were identical for both treatment arms, such as the cost of monitoring glucose control. Insulin treatment costs included average wholesale drug costs, wholesale delivery costs (syringes, alcohol pads), and costs of office staff educating patients. Glyburide costs were based on average wholesale drug costs. Downstream costs of potential inpatient evaluation for hypoglycemia were included in the model. Results: In our baseline model, glyburide was significantly less costly than insulin for the treatment of gestational diabetes. The average cost saving per patient based on wholesale drug costs and hospital costs was US$165.84. Actual retail drug savings and hospital charge savings are potentially considerably greater. The strongest determinant of cost savings was medication cost. The model was less sensitive to the one-time costs of inpatient treatment and patient education. Conclusion: Glyburide is less costly than insulin for the treatment of gestational diabetes. Cost models can be useful to physicians deciding between two equally efficacious medications, allowing them to incorporate information about their individual practice styles with a complex balance of cost implications.