Basal Insulin Regimens for Adults with Type 1 Diabetes Mellitus: A Cost-Utility Analysis
| Autor: | Elisabetta Fenu, Dalia Dawoud, Bernard Higgins, David Wonderling, Stephanie A. Amiel |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Blood Glucose Male Pediatrics medicine.medical_specialty Cost-Benefit Analysis medicine.medical_treatment Insulin Isophane Insulin Glargine 030209 endocrinology & metabolism Young Adult 03 medical and health sciences 0302 clinical medicine Insulin Detemir Internal medicine Humans Hypoglycemic Agents Medicine Computer Simulation 030212 general & internal medicine Insulin detemir Glycemic Cost–utility analysis Type 1 diabetes business.industry Insulin glargine Health Policy Insulin Public Health Environmental and Occupational Health Bayes Theorem Middle Aged medicine.disease Quality-adjusted life year Regimen Diabetes Mellitus Type 1 Models Economic Endocrinology England Female Quality-Adjusted Life Years business medicine.drug |
| Zdroj: | Value in Health. 20:1279-1287 |
| ISSN: | 1098-3015 |
| DOI: | 10.1016/j.jval.2017.05.021 |
| Popis: | Objectives To assess the cost-effectiveness of basal insulin regimens for adults with type 1 diabetes mellitus in England. Methods A cost-utility analysis was conducted in accordance with the National Institute for Health and Care Excellence reference case. The UK National Health Service and personal and social services perspective was used and a 3.5% discount rate was applied for both costs and outcomes. Relative effectiveness estimates were based on a systematic review of published trials and a Bayesian network meta-analysis. The IMS CORE Diabetes Model was used, in which net monetary benefit (NMB) was calculated using a threshold of £20,000 per quality-adjusted life-year (QALY) gained. A wide range of sensitivity analyses were conducted. Results Insulin detemir (twice daily) [iDet (bid)] had the highest mean QALY gain (11.09 QALYs) and NMB (£181,456) per patient over the model time horizon. Compared with the lowest cost strategy (insulin neutral protamine Hagedorn once daily), it had an incremental cost-effectiveness ratio of £7844/QALY gained. Insulin glargine (od) [iGlarg (od)] and iDet (od) were ranked as second and third, with NMBs of £180,893 and £180,423, respectively. iDet (bid) remained the most cost-effective treatment in all the sensitivity analyses performed except when high doses were assumed (>30% increment compared with other regimens), where iGlarg (od) ranked first. Conclusions iDet (bid) is the most cost-effective regimen, providing the highest QALY gain and NMB. iGlarg (od) and iDet (od) are possible options for those for whom the iDet (bid) regimen is not acceptable or does not achieve required glycemic control. |
| Databáze: | OpenAIRE |
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