Insulin therapy in type 2 diabetes patients failing oral agents: cost-effectiveness of biphasic insulin aspart 70/30 vs. insulin glargine in the US
| Autor: | Alan M. Garber, Andrew J. Palmer, Philip Raskin, William J. Valentine, Stéphane Roze, D Cobden, Joshua A. Ray, L Nicklasson |
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| Rok vydání: | 2007 |
| Předmět: |
Adult
Male medicine.medical_specialty Cost effectiveness Cost-Benefit Analysis Endocrinology Diabetes and Metabolism Insulin Isophane Administration Oral Insulin Glargine Biphasic Insulins Type 2 diabetes law.invention Diabetes Complications Insulin aspart Endocrinology Randomized controlled trial law Internal medicine Internal Medicine Humans Hypoglycemic Agents Insulin Medicine Cumulative incidence Treatment Failure Insulin Aspart Aged Glycemic Glycated Hemoglobin business.industry Insulin glargine Health Care Costs Middle Aged medicine.disease Insulin Long-Acting Treatment Outcome Diabetes Mellitus Type 2 Female Epidemiologic Methods business medicine.drug |
| Zdroj: | Diabetes, Obesity and Metabolism. 9:103-113 |
| ISSN: | 1463-1326 1462-8902 |
| DOI: | 10.1111/j.1463-1326.2006.00581.x |
| Popis: | Objectives: To project the long-term clinical and economic outcomes of treatment with biphasic insulin aspart 30 (BIAsp 70/30, 30% soluble and 70% protaminated insulin aspart) vs. insulin glargine in insulin-naive type 2 diabetes patients failing to achieve glycemic control with oral antidiabetic agents alone (OADs). Methods: Baseline patient characteristics and treatment effect data from the recent 'INITIATE' clinical trial served as input to a peer-reviewed, validated Markov/Monte-Carlo simulation model. INITIATE demonstrated improvements in HbA1c favouring BIAsp 70/30 vs. glargine (-0.43%; p < 0.005) and greater efficacy in reaching glycaemic targets among patients poorly controlled on OAD therapy. Effects on life expectancy (LE), quality-adjusted life expectancy (QALE), cumulative incidence of diabetes-related complications and direct medical costs (2004 USD) were projected over 35 years. Clinical outcomes and costs were discounted at a rate of 3.0% per annum. Sensitivity analyses were performed. Results: Improvements in glycaemic control were projected to lead to gains in LE (0.19 ± 0.24 years) and QALE (0.19 ± 0.17 years) favouring BIAsp 70/30 vs. glargine. Treatment with BIAsp 70/30 was also associated with reductions in the cumulative incidences of diabetes-related complications, notably in renal and retinal conditions. The incremental cost-effectiveness ratio was $46 533 per quality-adjusted life year gained with BIAsp 70/30 vs. glargine (for patients with baseline HbA1c ≥ 8.5%, it was $34 916). Total lifetime costs were compared to efficacy rates in both arms as a ratio, which revealed that the lifetime cost per patient treated successfully to target HbA1c levels of |
| Databáze: | OpenAIRE |
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