Diabetologie und Stoffwechsel 2007; 2 - A50
DOI: 10.1055/s-2007-984796

Long-term cost-effectiveness of insulin detemir versus NPH in type 2 diabetes patient: An evaluation in the German setting

W Valentine 1, M Aagren 1, R Kotchie 1, G Goodall 1
  • 1IMS Health Economics and Outcomes Research, Basel, Switzerland

Aims:

To evaluate the long-term clinical and economic outcomes associated with therapy conversion to insulin detemir (Levemir, Novo Nordisk) from human insulin (NPH) in type 2 diabetes patients in the German setting.

Material and Methods:

A validated computer simulation model of type 2 diabetes was used to make long-term projections of clinical and cost outcomes based on patient characteristics and treatment effects from the German cohort of the PREDICTIVE observational study. The trial indicated that therapy conversion from NPH to insulin detemir was associated with a significant improvement in glycemic control (HbA1c -0.6%) as well as reduced weight gain (-0.382kg/m2). Based on these clinical findings the model was used to evaluate life-expectancy, quality-adjusted life expectancy and direct medical costs for the detemir and NPH treatment arms. Future costs and clinical benefits were discounted at 5% per annum.

Results:

Treatment with insulin detemir was projected to improve life expectancy by approximately 0.13 years compared to NPH (7.14±0.12 versus 7.01±0.13 years). Quality-adjusted life expectancy was 0.28 quality-adjusted life years (QALYs) higher in the detemir arm than in the NPH arm (4.54±0.08 versus 4.26±0.08 QALYs). Direct medical costs over patient lifetimes were comparable in the detemir (€59,585±1,594) and NPH (€59,216±1,778) arms (difference €369). This led an incremental cost-effectiveness ratio of approximately €1,314 per QALY gained for insulin detemir versus NPH, which represents very good value for money by commonly reported standards in Germany. Acceptability curve analysis indicated that there was a 99% likelihood that insulin detemir would be considered good value for money at a willingness to pay threshold of €30,000 per QALY gained.

Conclusion:

This health economic evaluation, based on the findings of PREDICTIVE, indicates that treatment with insulin detemir is likely to be highly cost-effective versus NPH in type 2 diabetes patients in Germany.