An analysis of the short- and long-term cost-effectiveness of starting biphasic insulin aspart 30 in insulin-naive people with poorly controlled type 2 diabetes

作者：Shafie Asrul Akmal; Gupta Vishal; Baabbad Ranya; Hammerby Eva; Home Philip^*

来源：Diabetes Research and Clinical Practice, 2014, 106(2): 319-327.

DOI：10.1016/j.diabres.2014.08.024

• A(1)chieve
• Type 2 diabetes mellitus
• Cost-effectiveness
• Biphasic insulin aspart 30

Aim: This study aimed to assess the cost-effectiveness of starting insulin therapy with biphasic insulin aspart 30 (BIAsp 30) in people with type 2 diabetes inadequately controlled on oral glucose-lowering drugs in Saudi Arabia, India, Indonesia, and Algeria. %26lt;br%26gt;Methods: The IMS CORE Diabetes Model was used to evaluate economic outcomes associated with starting BIAsp 30, using baseline characteristics and treatment outcomes from the A(1)chieve study. Time horizons of 1 and 30 years were applied, with country-specific costs for complications, therapies, and background mortality. Incremental cost-effectiveness ratios (ICERs) are expressed as cost per quality-adjusted life-year (QALY) in local currencies, USD, and fractions of local GDP per capita (GDPc). Cost-effectiveness was pre-defined using the World Health Organization definition of %26lt;3.0 times GDPc. Comprehensive sensitivity analyses were performed. %26lt;br%26gt;Results: In the primary 30-year analyses, starting BIAsp 30 was associated with a projected increase in life expectancy of %26gt;1 year and was highly cost-effective, with ICERs of -0.03 (Saudi Arabia), 0.25 (India), 0.48 (India), 0.47 (Indonesia), and 0.46 (Algeria) GDPc/QALY. The relative risk of developing selected complications was reduced in all countries. Sensitivity analyses including cost of self-monitoring, treatment costs, and deterioration of glucose control with time showed the results to be robust. In a 1-year analysis, ICER per QALY gained was still cost-effective or highly cost-effective. %26lt;br%26gt;Conclusion: Starting BIAsp 30 in people with type 2 diabetes in the A(1)chieve study was found to be cost-effective across all country settings at 1- and 30-year time horizons, and usefully increased predicted life expectancy.

• 出版日期2014-11