Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun 22:12:333-343.
doi: 10.2147/CEOR.S244884. eCollection 2020.

Cost-Effectiveness of Insulin Glargine and Insulin Detemir in the Basal Regimen for Naïve Insulin Patients with Type 2 Diabetes Mellitus (T2DM) in Malaysia

Asrul Akmal Shafie  1 , Chin Hui Ng  2
Affiliations

Cost-Effectiveness of Insulin Glargine and Insulin Detemir in the Basal Regimen for Naïve Insulin Patients with Type 2 Diabetes Mellitus (T2DM) in Malaysia

Asrul Akmal Shafie et al. Clinicoecon Outcomes Res. .

Abstract

Objective: To compare the cost-effectiveness of long-acting insulin analogue (LAIA) (insulin Detemir and insulin Glargine) versus NPH insulin in the basal insulin regime for naïve insulin T2DM Malaysian patients.

Methods: The UKPDS-Outcome Model version 2.0 (UKPDS-OM2) was used to evaluate the cost and consequence of diabetes-related complication. The effectiveness of the insulin was derived from the literature review, and the patients' epidemiology characteristics were retrieved from the Malaysian Diabetes Registry. A discount rate of 3% was applied to both costs and health effects. Another simple mathematical model was used to compare the benefit of reducing the hypoglycemia events between LAIA and NPH insulin. The outputs of the models were combined to obtain the final result. One-way sensitivity analyses were performed to assess the uncertainties.

Results: The net cost difference (without accounting for hypoglycemia) was RM4868 for insulin Glargine and RM6026 for insulin Detemir. The saving from preventing severe hypoglycemia was RM4377 for insulin Glargine and RM12,753 for insulin Detemir. The total additional QALY gained from insulin Glargine was 0.1317 and from insulin Detemir was 0.8376. The sensitivity analysis shows the discount rate, and drug acquisition cost may affect the incremental cost-effectiveness ratio (ICER) value.

Conclusion: Both insulin Detemir and Glargine are cost-effective compared to NPH insulin for T2DM patients, especially when the benefit of reducing the hypoglycemia event rate is taken into account.

Keywords: cost-effectiveness analysis; insulin Detemir; insulin Glargine; type 2 diabetes mellitus.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
A simple cost and consequences mathematic model approach to evaluate the reduced hypoglycemia in T2DM treated with LAIA or NPH insulin. The cost of managing hypoglycemia for LAIA= Total number of hypoglycemia event rate × Total cost of managing hypoglycemia per episode. The cost of managing hypoglycemia for NPH insulin= Total number of hypoglycemia event rate × Total cost of managing hypoglycemia per episode. Total QALY for LAIA= Total hypoglycemia event/year × disutility event per episode. Total QALY for NPH= Total hypoglycemia event/year × disutility event per episode. Abbreviations: Δ cost, change in cost; Δ QALY, change in quality-adjusted life year; QALY, quality-adjusted life year; LAIA, long-acting insulin analogue; NPH Insulin, neutral protamine Hagedorn insulin; T2DM, type 2 diabetes mellitus.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Ruxyn T More than a million adults in Malaysia are not even aware they have diabetes. SAYS. 2018.
    1. Hussein Z, Taher SW, Gilcharan Singh HK, Chee Siew Swee W. Diabetes care in Malaysia: problems, new models, and solutions. Ann Glob Health. 2015;81(6):851–862. doi:10.1016/j.aogh.2015.12.016 - DOI - PubMed
    1. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837–853. doi:10.1016/S0140-6736(98)07019-6 - DOI - PubMed
    1. Petznick A. Insulin management of type 2 diabetes mellitus. Am Fam Physician. 2011;84(2):183–190. - PubMed
    1. Buse JB, Bigger JT, Byington RP, et al. Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: design and methods. Am J Cardiol. 2007;99(12):21i–33i. doi:10.1016/j.amjcard.2007.03.003 - DOI - PubMed

Grants and funding

This study is not funded by any organization.