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Seetharaman R, Monteiro R, Maradia J, Tripathi R. IcoSema: unveiling the future of diabetes management from a clinical pharmacology perspective. J Basic Clin Physiol Pharmacol 2024; 0:jbcpp-2024-0058. [PMID: 38856001 DOI: 10.1515/jbcpp-2024-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/25/2024] [Indexed: 06/11/2024]
Abstract
IcoSema, a groundbreaking approach to diabetes management, combines insulin icodec and semaglutide to offer a transformative treatment option. Insulin icodec delivers consistent glucose-lowering effects with once-weekly dosing, while semaglutide, a GLP-1 agonist, stimulates insulin secretion and aids in weight loss. This comprehensive article evaluates the potential of IcoSema from a clinical pharmacology perspective, examining the pharmacokinetics, efficacy, safety, compliance and cost-effectiveness of its individual components, as well as considering comparable combination therapies like iGlarLixi and IDegLira. By analysing these crucial factors, the article aims to determine the potential of IcoSema in the field of diabetes management. The combination of insulin icodec and semaglutide has the potential to provide improved glycaemic control, weight management, and simplified treatment regimens, addressing common challenges faced in diabetes management. Safety, compliance and cost considerations are important aspects of evaluating this combination therapy. Ongoing trials investigating IcoSema are expected to provide valuable insights into its efficacy, safety and comparative effectiveness. By addressing concerns such as potential side effects, individual patient response and drug interactions, healthcare providers can optimize treatment outcomes and enhance the management of type 2 diabetes.
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Affiliation(s)
- Rajmohan Seetharaman
- Department of Pharmacology and Therapeutics, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, India
| | - Rhea Monteiro
- Department of Pharmacology and Therapeutics, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, India
| | - Jay Maradia
- Department of Pharmacology and Therapeutics, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, India
| | - Raakhi Tripathi
- Department of Pharmacology and Therapeutics, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, India
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Hussin SA, Mohamad NA, Othman MK, Wan Mohamed WMI. Evaluating the Impact of Intensifying Treatment from Human to Analogue Insulin on Glycaemic Control and Insulin Expenditure in Patients with Type 2 Diabetes: A Retrospective Cohort Study. Malays J Med Sci 2024; 31:159-169. [PMID: 38694591 PMCID: PMC11057824 DOI: 10.21315/mjms2024.31.2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/28/2023] [Indexed: 05/04/2024] Open
Abstract
Background Achieving good glycaemic control is essential to reducing the risk of diabetes complications. Insulin is the most effective therapy for achieving good glycaemic control; however, it is associated with a higher risk of hypoglycaemia, especially with human insulin. This study aimed to evaluate the efficacy of intensification from human to analogue insulin and its added cost. Methods This retrospective study was conducted at the Hospital Universiti Sains Malaysia (HUSM). Patients with type 2 diabetes mellitus (T2DM) who underwent intensification for at least 3 months from human to analogue insulin were included in this study. The patients' medical records, haemoglobin A1c (Hba1c) and fasting blood sugar (FBS) were retrieved. The total cost pre- and post-intensification of insulin was obtained from the pharmacy database. Differences in HbA1c, FBS and total insulin cost pre- and post-intensification were analysed. Results A total of 163 patients with T2DM who had intensification from human to analogue insulin were included in this study. HbA1c and FBS levels were significantly lower in analogue insulin. However, the differences were not clinically significant, as the mean reduction in HbA1c was less than 0.5%. Meanwhile, the total costs of analogue insulin for 3 months were higher. Conclusion There were no clinically significant improvements in patients' HbA1c and FBS after the intensification of insulin, despite the extra costs spent. Hence, it is vital to choose the right group of patients to receive an insulin analogue to maximise its benefit but at the most optimal cost.
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Affiliation(s)
- Siti Aisyah Hussin
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Nur Aimi Mohamad
- Department of Pharmacy, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Khairi Othman
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Wan Mohd Izani Wan Mohamed
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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Eamer G, Povolo CA, Petropoulos JA, Ohinmaa A, Vanhouwelingen L. Observation, Aspiration, or Tube Thoracostomy for Primary Spontaneous Pneumothorax: A Systematic Review, Meta-Analysis, and Cost-Utility Analysis. Chest 2023; 164:1007-1018. [PMID: 37209773 DOI: 10.1016/j.chest.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) has several commonly used management strategies: observation, aspiration, and chest tube placement. Economic modelling of pooled data comparing techniques has not been performed. RESEARCH QUESTION Based on studies from the past 20 years, which approach to management of PSP delivers the highest utility? STUDY DESIGN AND METHODS A systematic review of PSP management strategies (observation, aspiration, or chest tube placement) included in the Medline and EMBASE databases from January 1, 2000, through April 10, 2020, was conducted. Text screening, bias assessment, and data extraction were performed by two authors (G. E. and C. A. P.). Inclusion and exclusion criteria were defined a priori. The primary outcome was PSP resolution after the initial intervention. Secondary outcomes were PSP recurrence, length of stay, rate of surgical management, and complications. The meta-analysis compared treatment arms; dichotomous outcomes were reported as relative risk (RRs) and continuous outcomes were reported as mean differences. A cost-utility analysis within the Canadian health care system context with deterministic and probabilistic sensitivity analyses was performed. RESULTS Five thousand one hundred seventy-nine articles were identified; after screening, 22 articles were included. Most trials showed a high risk of bias, but randomized trials showed a lower risk. Compared with chest tube placement, observation (mean difference, 5.17; 95% CI, 3.75-6.59; P < .01; I2 = 62%) and aspiration (mean difference, 2.72; 95% CI, 2.39-3.04; P < .01; I2 = 0%) showed a shorter length of stay. Compared with observation, chest tube placement (RR, 0.81; 95% CI, 0.71-0.91; P < .01; I2 = 62%) and aspiration (RR, 0.73; 95% CI, 0.61-0.88; P < .01; I2 = 67%) showed higher resolution without additional intervention. Two-year recurrence rates did not differ between management strategies. Observation showed the best utility (0.82) and lowest cost; observation was the optimal strategy in 98.2% of Monte Carlo simulations. INTERPRETATION Observation is the dominant choice compared with aspiration and chest tube placement for PSP. It should be considered as the first-line therapy in appropriately selected patients.
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Affiliation(s)
- Gilgamesh Eamer
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
| | - Christopher A Povolo
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Lisa Vanhouwelingen
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; McMaster Children's Hospital, Hamilton, ON, Canada
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4
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Nosrati M, Ahmadi Fariman S, Saiyarsarai P, Nikfar S. Pharmacoeconomic evaluation of insulin aspart and glargine in type 1 and 2 diabetes mellitus in Iran. J Diabetes Metab Disord 2023; 22:817-825. [PMID: 37255793 PMCID: PMC10225402 DOI: 10.1007/s40200-023-01209-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/05/2023] [Indexed: 06/01/2023]
Abstract
Purpose The higher costs of insulin analogs including short-acting insulin aspart (IAsp) and long-acting insulin glargine (IGla) have restricted their widespread uptake despite having improved pharmacokinetic and pharmacodynamic properties and patient convenience. This study aims to evaluate the cost-effectiveness of IAsp versus Regular Insulin (RI) and IGla versus NPH Insulin in type 1 and 2 diabetes from the perspective of the Iranian healthcare system. Methods Clinical data including HbA1c levels, hypoglycemia, weight gain, and health-related quality of life were derived from the included systematic review and meta-analysis studies. Different methods of pharmacoeconomic evaluation were used for an annual time horizon. Utility decrements for diabetes-related complications were extracted from the literature. Direct medical costs were calculated in 2022 prices. A one-way sensitivity analysis was also performed. Results In type 1 diabetes, IAsp was associated with more costs and effects in terms of reducing HbA1c compared with RI. An incremental cost of $83 was estimated to obtain an additional 1% reduction in HbA1c per patient per year. Similarly, an incremental cost of $16 was estimated for IGla compared with NPH. In type 2 diabetes, IAsp and RI were associated with equal efficacy and safety. For IGla versus NPH, the incremental cost-effectiveness ratio was calculated at $1975 per quality-adjusted life-year. The robustness of the result was confirmed through sensitivity analysis. Conclusion Insulin analogs, IAsp and IGla, are cost-effective for type 1 diabetes versus human insulins, RI and NPH. For type 2 diabetes, IAsp is not cost-effective when compared with RI. For IGla versus NPH, however, the incremental cost-effectiveness ratio seems to be within the accepted thresholds.
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Affiliation(s)
- Marzieh Nosrati
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, 16 Azar St., Enghelab-E Islami Sq, Tehran, Iran
| | - Soroush Ahmadi Fariman
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, 16 Azar St., Enghelab-E Islami Sq, Tehran, Iran
| | - Parisa Saiyarsarai
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, 16 Azar St., Enghelab-E Islami Sq, Tehran, Iran
| | - Shekoufeh Nikfar
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, 16 Azar St., Enghelab-E Islami Sq, Tehran, Iran
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McCall AL, Lieb DC, Gianchandani R, MacMaster H, Maynard GA, Murad MH, Seaquist E, Wolfsdorf JI, Wright RF, Wiercioch W. Management of Individuals With Diabetes at High Risk for Hypoglycemia: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2023; 108:529-562. [PMID: 36477488 DOI: 10.1210/clinem/dgac596] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Indexed: 12/12/2022]
Abstract
CONTEXT Hypoglycemia in people with diabetes is common, especially in those taking medications such as insulin and sulfonylureas (SU) that place them at higher risk. Hypoglycemia is associated with distress in those with diabetes and their families, medication nonadherence, and disruption of life and work, and it leads to costly emergency department visits and hospitalizations, morbidity, and mortality. OBJECTIVE To review and update the diabetes-specific parts of the 2009 Evaluation and Management of Adult Hypoglycemic Disorders: Endocrine Society Clinical Practice Guideline and to address developing issues surrounding hypoglycemia in both adults and children living with diabetes. The overriding objectives are to reduce and prevent hypoglycemia. METHODS A multidisciplinary panel of clinician experts, together with a patient representative, and methodologists with expertise in evidence synthesis and guideline development, identified and prioritized 10 clinical questions related to hypoglycemia in people living with diabetes. Systematic reviews were conducted to address all the questions. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make recommendations. RESULTS The panel agreed on 10 questions specific to hypoglycemia risk and prevention in people with diabetes for which 10 recommendations were made. The guideline includes conditional recommendations for use of real-time continuous glucose monitoring (CGM) and algorithm-driven insulin pumps in people with type 1 diabetes (T1D), use of CGM for outpatients with type 2 diabetes at high risk for hypoglycemia, use of long-acting and rapid-acting insulin analogs, and initiation of and continuation of CGM for select inpatient populations at high risk for hypoglycemia. Strong recommendations were made for structured diabetes education programs for those at high risk for hypoglycemia, use of glucagon preparations that do not require reconstitution vs those that do for managing severe outpatient hypoglycemia for adults and children, use of real-time CGM for individuals with T1D receiving multiple daily injections, and the use of inpatient glycemic management programs leveraging electronic health record data to reduce the risk of hypoglycemia. CONCLUSION The recommendations are based on the consideration of critical outcomes as well as implementation factors such as feasibility and values and preferences of people with diabetes. These recommendations can be used to inform clinical practice and health care system improvement for this important complication for people living with diabetes.
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Affiliation(s)
- Anthony L McCall
- University of Virginia Medical School, Department of Medicine, Division of Endocrinology and Metabolism, Charlottesville, VA 22901, USA
| | - David C Lieb
- Eastern Virginia Medical School, Division of Endocrine and Metabolic Disorders, Department of Medicine, Norfolk, VA 23510, USA
| | | | | | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN 55905, USA
| | - Elizabeth Seaquist
- Diabetes Center and the Division of Endocrinology & Metabolism, Minneapolis, MN 55455, USA
| | - Joseph I Wolfsdorf
- Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | - Wojtek Wiercioch
- McMaster University GRADE Centre and Michael G. DeGroote Cochrane Canada Centre Department of Health Research Methods, Evidence, and Impact, Hamilton, ON, L8S 4L8, Canada
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Saunders H, Pham B, Loong D, Mishra S, Ashoor HM, Antony J, Darvesh N, Bains SK, Jamieson M, Plett D, Trivedi S, Yu CH, Straus SE, Tricco AC, Isaranuwatchai W. The Cost-Effectiveness of Intermediate-Acting, Long-Acting, Ultralong-Acting, and Biosimilar Insulins for Type 1 Diabetes Mellitus: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1235-1252. [PMID: 35341688 DOI: 10.1016/j.jval.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 11/15/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The incidence of type 1 diabetes mellitus is increasing every year requiring substantial expenditure on treatment and complications. A systematic review was conducted on the cost-effectiveness of insulin formulations, including ultralong-, long-, or intermediate-acting insulin, and their biosimilar insulin equivalents. METHODS MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, HTA, and NHS EED were searched from inception to June 11, 2021. Cost-effectiveness and cost-utility analyses were included if insulin formulations in adults (≥ 16 years) with type 1 diabetes mellitus were evaluated. Two reviewers independently screened titles, abstracts, and full-text articles, extracted study data, and appraised their quality using the Drummond 10-item checklist. Costs were converted to 2020 US dollars adjusting for inflation and purchasing power parity across currencies. RESULTS A total of 27 studies were included. Incremental cost-effectiveness ratios ranged widely across the studies. All pairwise comparisons (11 of 11, 100%) found that ultralong-acting insulin was cost-effective compared with other long-acting insulins, including a long-acting biosimilar. Most pairwise comparisons (24 of 27, 89%) concluded that long-acting insulin was cost-effective compared with intermediate-acting insulin. Few studies compared long-acting insulins with one another. CONCLUSIONS Long-acting insulin may be cost-effective compared with intermediate-acting insulin. Future studies should directly compare biosimilar options and long-acting insulin options and evaluate the long-term consequences of ultralong-acting insulins.
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Affiliation(s)
- Hailey Saunders
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Ba' Pham
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Desmond Loong
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Sujata Mishra
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Huda M Ashoor
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jesmin Antony
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Nazia Darvesh
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Silkan K Bains
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Margaret Jamieson
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Donna Plett
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Srushhti Trivedi
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Catherine H Yu
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
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Bhat AA, Tandon N, Tandon R. Pyrrolidine Derivatives as Anti‐diabetic Agents: Current Status and Future Prospects. ChemistrySelect 2022. [DOI: 10.1002/slct.202103757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Aeyaz Ahmad Bhat
- Department of Chemistry School of Physical Sciences Lovely Professional University Phagwara 144411 India
| | - Nitin Tandon
- Department of Chemistry School of Physical Sciences Lovely Professional University Phagwara 144411 India
| | - Runjhun Tandon
- Department of Chemistry School of Physical Sciences Lovely Professional University Phagwara 144411 India
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Gao CC, Espinoza Suarez NR, Toloza FJK, Malaga Zuniga AS, McCarthy SR, Boehmer KR, Yao L, Fu S, Brito JP. Patients' Perspective About the Cost of Diabetes Management: An Analysis of Online Health Communities. Mayo Clin Proc Innov Qual Outcomes 2021; 5:898-906. [PMID: 34585085 PMCID: PMC8455864 DOI: 10.1016/j.mayocpiqo.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To understand the perspectives of persons' living with diabetes about the increasing cost of diabetes management through an analysis of online health communities (OHCs) and the impact of persons' participation in OHCs on their capacity and treatment burden. Patients and Methods A qualitative study of 556 blog posts submitted between January 1, 2007 and December 31, 2017 to 4 diabetes social networking sites was conducted between March 2018 and July 2019. All posts were coded inductively using thematic analysis procedures. Eton's Burden of Treatment Framework and Boehmer's Theory of Patient Capacity directed triangulation of themes with existing theory. Results Three themes were identified: (1) cost barriers to care: participants describe individual and systemic cost barriers that inhibit prescribed therapy goals; (2) impact of financial cost on health: participants describe the financial effects of care on their physical and emotional health; and (3) saving strategies to overcome cost impact: participants discuss practical strategies that help them achieve therapy goals. Finally, we also identify that the use of OHCs serves to increase persons' capacity with the potential to decrease treatment burden, ultimately improving mental and physical health. Conclusion High cost for diabetes care generated barriers that negatively affected physical health and emotional states. Participant-shared experiences in OHCs increased participants' capacity to manage the burden. Potential solutions include cost-based shared decision-making tools and advocacy for policy change.
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Key Words
- BS, blood sugar
- BoTF, Burden of Treatment Framework
- DME, Durable Medical Equipment
- HMO, health maintenance organization
- IDDM, insulin-dependent diabetes mellitus
- IRB, institutional review board
- OHC, online health community
- PLWD, person living with diabetes
- PPA, Partnership for Prescription Assistance
- RX, prescription
- T1D, type 1 diabetes
- TPC, Theory of Patient Capacity
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Affiliation(s)
- Catherine C Gao
- Mayo Clinic Alix School of Medicine.,Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | | | - Freddy J K Toloza
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.,Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock
| | - Ariana S Malaga Zuniga
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.,Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
| | - Sarah R McCarthy
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Lixia Yao
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Sunyang Fu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.,Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Ellyson AM, Basu A. Do pharmaceutical prices rise anticipating branded competition? HEALTH ECONOMICS 2021; 30:1070-1081. [PMID: 33684255 DOI: 10.1002/hec.4248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/29/2020] [Accepted: 01/30/2021] [Indexed: 06/12/2023]
Abstract
Growth in pharmaceutical prices is a major policy issue in the United States. Competition is encouraged to counteract such growth, yet less is known about the effect of brand competition on prices. We discover a unique feature of this market by studying the pricing strategies of incumbent drug manufacturers under tiered-insurance anticipating branded competition. Using the insulin market as a natural experiment, we exploit exogenous variation in several potential entrants' completion of clinical trials to identify the effect of drug pipeline pressure on the prices of incumbent drugs. We find that pipeline pressure exerts cumulative and significant upward pressure on prices of incumbent drugs. In the insulin market such pressure explained 10.5% of the growth of prices. We were able to replicate these findings among incumbents with other emerging biosimilars. Insurance designs that fail to promote price competition through negotiations and value-based principles may contribute to such price increases.
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Affiliation(s)
- Alice M Ellyson
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior, and Development (CHBD), Seattle Children's Research Institute, Seattle, Washington, USA
| | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington, USA
- Department of Health Services, University of Washington, Seattle, Washington, USA
- Department of Economics, University of Washington, Seattle, Washington, USA
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Cromer SJ, Wexler DJ, Kazemian P. Correlates of analog vs human basal insulin use among individuals with type 2 diabetes: A cross-sectional study. Diabetes Res Clin Pract 2021; 175:108825. [PMID: 33887352 PMCID: PMC8217374 DOI: 10.1016/j.diabres.2021.108825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/24/2021] [Accepted: 04/15/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Given the shift from use of less expensive human to costlier analog insulins for treatment of type 2 diabetes (T2D), we examine characteristics and glycemic control associated with type of basal insulin use. METHODS We analyzed respondents with T2D in six consecutive National Health and Nutrition Examination Survey (NHANES) cycles (2005-2016). Logistic regression models examined associations between demographics, socioeconomic factors, and NHANES cycle with (1) type of basal insulin use and (2) hemoglobin A1c <8.0% and <7.0% according to basal insulin type. FINDINGS Basal insulin use increased from 9.6% to 17.2% of respondents with T2D between 2005 and 2016. Among 723 respondents meeting inclusion criteria, the proportion using analog basal insulin rose from 58% to 88%. African American (aOR 0.42, 95% CI 0.24-0.74) and Hispanic (aOR 0.54, 95% CI 0.30-0.96) respondents had lower odds of analog basal insulin use than non-Hispanic White respondents in adjusted and unadjusted models. Older age and having health insurance, but not type of basal insulin use, associated with meeting HbA1c targets. INTERPRETATION Non-White NHANES respondents were less likely to use analog basal insulin than White respondents. Increased analog basal insulin use between 2005 and 2016 was not associated with improved glycemic control.
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Affiliation(s)
- Sara J Cromer
- Massachusetts General Hospital, Boston, MA 02114, United States; Harvard Medical School, Boston, MA 02115, United States.
| | - Deborah J Wexler
- Massachusetts General Hospital, Boston, MA 02114, United States; Harvard Medical School, Boston, MA 02115, United States.
| | - Pooyan Kazemian
- Case Western Reserve University, Cleveland, OH 44106, United States.
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Lefever E, Vliebergh J, Mathieu C. Improving the treatment of patients with diabetes using insulin analogues: current findings and future directions. Expert Opin Drug Saf 2021; 20:155-169. [PMID: 33249944 DOI: 10.1080/14740338.2021.1856813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Introduction: The aim of insulin replacement in insulin-deficient people (type 1 diabetes, pancreatic causes of diabetes, long-standing type 2 diabetes) is to approximate the physiologic insulin action profile as closely as possible. However, short-acting human insulins start too slow and act too long, causing postprandial hyperglycemia and delayed hypoglycemia, while the insulin action profile of long-acting human insulins is too variable in duration and strength of action, leading to insufficient basal insulin covering and peak insulin levels after injection causing early nocturnal hypoglycemia. Insulin analogues were designed to overcome these shortcomings. In insulin-resistant people (type 2 diabetes), insulin analogues contribute to more efficient and safer insulin supplementation. Areas covered: In this review, we describe the unmet needs for insulin therapy, the currently available short- and long-acting insulin analogues and some considerations on cardiovascular outcomes, use in special populations, and cost-effectiveness. Finally, we discuss what is new in the field of insulin analogues. Expert opinion: The development of insulin analogues is an important step in diabetes treatment. Despite many patients meeting their glycemic targets with the newest analogues, hypoglycemic episodes remain a major problem. More physiologic insulin regimens, with glucose-sensitive or organ-targeting insulin analogues may be the answer to these issues.
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Affiliation(s)
- Eveline Lefever
- Department of Endocrinology, University Hospitals Leuven , Leuven, Belgium
| | - Joke Vliebergh
- Department of Endocrinology, University Hospitals Leuven , Leuven, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven , Leuven, Belgium
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Siegel KR, Ali MK, Zhou X, Ng BP, Jawanda S, Proia K, Zhang X, Gregg EW, Albright AL, Zhang P. Cost-effectiveness of Interventions to Manage Diabetes: Has the Evidence Changed Since 2008? Diabetes Care 2020; 43:1557-1592. [PMID: 33534729 DOI: 10.2337/dci20-0017] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/03/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To synthesize updated evidence on the cost-effectiveness (CE) of interventions to manage diabetes, its complications, and comorbidities. RESEARCH DESIGN AND METHODS We conducted a systematic literature review of studies from high-income countries evaluating the CE of diabetes management interventions recommended by the American Diabetes Association (ADA) and published in English between June 2008 and July 2017. We also incorporated studies from a previous CE review from the period 1985-2008. We classified the interventions based on their strength of evidence (strong, supportive, or uncertain) and levels of CE: cost-saving (more health benefit at a lower cost), very cost-effective (≤$25,000 per life year gained [LYG] or quality-adjusted life year [QALY]), cost-effective ($25,001-$50,000 per LYG or QALY), marginally cost-effective ($50,001-$100,000 per LYG or QALY), or not cost-effective (>$100,000 per LYG or QALY). Costs were measured in 2017 U.S. dollars. RESULTS Seventy-three new studies met our inclusion criteria. These were combined with 49 studies from the previous review to yield 122 studies over the period 1985-2017. A large majority of the ADA-recommended interventions remain cost-effective. Specifically, we found strong evidence that the following ADA-recommended interventions are cost-saving or very cost-effective: In the cost-saving category are 1) ACE inhibitor (ACEI)/angiotensin receptor blocker (ARB) therapy for intensive hypertension management compared with standard hypertension management, 2) ACEI/ARB therapy to prevent chronic kidney disease and/or end-stage renal disease in people with albuminuria compared with no ACEI/ARB therapy, 3) comprehensive foot care and patient education to prevent and treat foot ulcers among those at moderate/high risk of developing foot ulcers, 4) telemedicine for diabetic retinopathy screening compared with office screening, and 5) bariatric surgery compared with no surgery for individuals with type 2 diabetes (T2D) and obesity (BMI ≥30 kg/m2). In the very cost-effective category are 1) intensive glycemic management (targeting A1C <7%) compared with conventional glycemic management (targeting an A1C level of 8-10%) for individuals with newly diagnosed T2D, 2) multicomponent interventions (involving behavior change/education and pharmacological therapy targeting hyperglycemia, hypertension, dyslipidemia, microalbuminuria, nephropathy/retinopathy, secondary prevention of cardiovascular disease with aspirin) compared with usual care, 3) statin therapy compared with no statin therapy for individuals with T2D and history of cardiovascular disease, 4) diabetes self-management education and support compared with usual care, 5) T2D screening every 3 years starting at age 45 years compared with no screening, 6) integrated, patient-centered care compared with usual care, 7) smoking cessation compared with no smoking cessation, 8) daily aspirin use as primary prevention for cardiovascular complications compared with usual care, 9) self-monitoring of blood glucose three times per day compared with once per day among those using insulin, 10) intensive glycemic management compared with conventional insulin therapy for T2D among adults aged ≥50 years, and 11) collaborative care for depression compared with usual care. CONCLUSIONS Complementing professional treatment recommendations, our systematic review provides an updated understanding of the potential value of interventions to manage diabetes and its complications and can assist clinicians and payers in prioritizing interventions and health care resources.
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Affiliation(s)
- Karen R Siegel
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mohammed K Ali
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.,Hubert Department of Global Health and Department of Family and Preventive Medicine, Emory University, Atlanta, GA
| | - Xilin Zhou
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Boon Peng Ng
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.,College of Nursing and Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL
| | - Shawn Jawanda
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Krista Proia
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Xuanping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ann L Albright
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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Shafie AA, Ng CH. Cost-Effectiveness of Insulin Glargine and Insulin Detemir in the Basal Regimen for Naïve Insulin Patients with Type 2 Diabetes Mellitus (T2DM) in Malaysia. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:333-343. [PMID: 32606850 PMCID: PMC7319511 DOI: 10.2147/ceor.s244884] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/29/2020] [Indexed: 12/20/2022] Open
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.
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Affiliation(s)
- Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Penang, Malaysia
| | - Chin Hui Ng
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ipoh 30450, Perak, Malaysia
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Abstract
BACKGROUND Since the discovery of insulin, it was the only drug available for the treatment of diabetes until the development of sulfonylureas and biguanides 50 years later. But even with the availability of oral glucose-lowering drugs, insulin supplementation was often needed to achieve good glucose control in type 2 diabetes. Insulin NPH became the basal insulin therapy of choice and adding NPH to metformin and/or sulfonylureas became the standard of care until basal insulin analogs were developed and new glucose-lowering drugs became available. AREAS OF UNCERTAINTY The advantages in cost-benefit of insulin analogs and their combination with new glucose-lowering drugs are still a matter of debate. There is no general agreement on how to avoid inertia by prescribing insulin therapy in type 2 diabetes when really needed, as reflected by the diversity of recommendations in the current clinical practice guidelines. DATA SOURCES When necessary for this review, a systematic search of the evidence was done in PubMed and Cochrane databases. THERAPEUTIC ADVANCES Adding new oral glucose-lowering drugs to insulin such as DPP-4 inhibitors lead to a modest HbA1c reduction without weight gain and no increase in hypoglycemia. When SGLT-2 inhibitors are added instead, there is a slightly higher HbA1c reduction, but with body weight and blood pressure reduction. The downside is the increase in genital tract infections. GLP-1 receptor agonists have become the best alternative when basal insulin fails, particularly using fixed ratio combinations. Rapid-acting insulins via the inhaled route may also become an alternative for insulin supplementation and/or intensification. "Smart insulins" are under investigation and may become available for clinical use in the near future. CONCLUSIONS Aggressive weight loss strategies together with the new glucose-lowering drugs which do not cause hypoglycemia nor weight gain should limit the number of patients with type 2 diabetes needing insulin. Nevertheless, because of therapeutic inertia and the progressive nature of the disease, many need at least a basal insulin supplementation and insulin analogs are the best choice as they become more affordable. Fixed ratio combinations with GLP1 receptor agonists are a good choice for intensification of insulin therapy.
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Lee TY, Kuo S, Yang CY, Ou HT. Cost-effectiveness of long-acting insulin analogues vs intermediate/long-acting human insulin for type 1 diabetes: A population-based cohort followed over 10 years. Br J Clin Pharmacol 2020; 86:852-860. [PMID: 31782975 DOI: 10.1111/bcp.14188] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/02/2019] [Accepted: 11/10/2019] [Indexed: 12/22/2022] Open
Abstract
AIMS This study assessed the cost-effectiveness of long-acting insulin analogues (LAIAs) vs intermediate/long-acting human insulin (ILAHI) for patients with type 1 diabetes (T1D) in real-world clinical practice. METHODS Individual-level analyses were conducted within a longitudinal population-based cohort of 540 propensity score-matched T1D patients (LAIAs, n = 270; ILAHI, n = 270) with over 10 years of follow-up using Taiwan's National Health Insurance Research Database, 2004-2013, from third-party payer and healthcare sector perspectives. The study outcomes included the number needed to treat (NNT) to prevent one case of clinical events (eg, hypoglycaemia, diabetes-related complications), medical costs, and cost per case of events prevented. Cost estimates are presented in 2013 British pounds (GBP, £). RESULTS The NNTs using LAIAs vs ILAHI to avoid one case of hypoglycaemia requiring medical assistance, outpatient hypoglycaemia and any diabetes-related complications were 12, 9 and 10 for mean follow-up periods of 5.84, 6.02 and 3.62 years, respectively. From third-party payer and healthcare sector perspectives, using LAIAs instead of ILAHI saved GBP6924-GBP7116 per case of hypoglycaemia requiring medical assistance prevented, GBP5346-GBP5508 per case of outpatient hypoglycaemia prevented, and GBP3570-GBP3680 per case of any diabetes-related complications prevented. Sensitivity analyses considering sampling uncertainty showed that using LAIAs over ILAHI yields at least a 76% probability of cost-saving for avoiding one case of hypoglycaemia requiring medical assistance, outpatient hypoglycaemia or any diabetes-related complications. CONCLUSIONS This real-world evidence reveals that compared with ILAHI, the greater pharmaceutical costs associated with LAIAs for patients with T1D could be substantially offset by savings from averted hypoglycaemia or diabetes-related complications.
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Affiliation(s)
- Tsung-Ying Lee
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shihchen Kuo
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Chen-Yi Yang
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huang-Tz Ou
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Xu Y, Gomes T, Mamdani MM, Juurlink DN, Cadarette SM, Tadrous M. Analysis of Trends in Insulin Utilization and Spending Across Canada From 2010 to 2015. Can J Diabetes 2019; 43:179-185.e1. [DOI: 10.1016/j.jcjd.2018.08.190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/20/2018] [Accepted: 08/09/2018] [Indexed: 01/01/2023]
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Fullerton B, Siebenhofer A, Jeitler K, Horvath K, Semlitsch T, Berghold A, Gerlach FM. Short-acting insulin analogues versus regular human insulin for adult, non-pregnant persons with type 2 diabetes mellitus. Cochrane Database Syst Rev 2018; 12:CD013228. [PMID: 30556900 PMCID: PMC6517032 DOI: 10.1002/14651858.cd013228] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The use of short-acting insulin analogues (insulin lispro, insulin aspart, insulin glulisine) for adult, non-pregnant people with type 2 diabetes is still controversial, as reflected in many scientific debates. OBJECTIVES To assess the effects of short-acting insulin analogues compared to regular human insulin in adult, non-pregnant people with type 2 diabetes mellitus. SEARCH METHODS For this update we searched CENTRAL, MEDLINE, Embase, the WHO ICTRP Search Portal, and ClinicalTrials.gov to 31 October 2018. We placed no restrictions on the language of publication. SELECTION CRITERIA We included all randomised controlled trials with an intervention duration of at least 24 weeks that compared short-acting insulin analogues to regular human insulin in the treatment of people with type 2 diabetes, who were not pregnant. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias. We assessed dichotomous outcomes by risk ratios (RR), and Peto odds ratios (POR), with 95% confidence intervals (CI). We assessed continuous outcomes by mean differences (MD) with 95% CI. We assessed trials for certainty of the evidence using the GRADE approach. MAIN RESULTS We identified 10 trials that fulfilled the inclusion criteria, randomising 2751 participants; 1388 participants were randomised to receive insulin analogues and 1363 participants to receive regular human insulin. The duration of the intervention ranged from 24 to 104 weeks, with a mean of about 41 weeks. The trial populations showed diversity in disease duration, and inclusion and exclusion criteria. None of the trials were blinded, so the risk of performance bias and detection bias, especially for subjective outcomes, such as hypoglycaemia, was high in nine of 10 trials from which we extracted data. Several trials showed inconsistencies in the reporting of methods and results.None of the included trials defined all-cause mortality as a primary outcome. Six trials provided Information on the number of participants who died during the trial, with five deaths out of 1272 participants (0.4%) in the insulin analogue groups and three deaths out of 1247 participants (0.2%) in the regular human insulin groups (Peto OR 1.66, 95% CI 0.41 to 6.64; P = 0.48; moderate-certainty evidence). Six trials, with 2509 participants, assessed severe hypoglycaemia differently, therefore, we could not summarise the results with a meta-analysis. Overall, the incidence of severe hypoglycaemic events was low, and none of the trials showed a clear difference between the two intervention arms (low-certainty evidence).The MD in glycosylated haemoglobin A1c (HbA1c) change was -0.03% (95% CI -0.16 to 0.09; P = 0.60; 9 trials, 2608 participants; low-certainty evidence). The 95% prediction ranged between -0.31% and 0.25%. The MD in the overall number of non-severe hypoglycaemic episodes per participant per month was 0.08 events (95% CI 0.00 to 0.16; P = 0.05; 7 trials, 2667 participants; very low-certainty evidence). The 95% prediction interval ranged between -0.03 and 0.19 events per participant per month. The results provided for nocturnal hypoglycaemic episodes were of questionable validity. Overall, there was no clear difference between the two short-acting insulin analogues and regular human insulin. Two trials assessed health-related quality of life and treatment satisfaction, but we considered the results for both outcomes to be unreliable (very low-certainty evidence).No trial was designed to investigate possible long term effects (all-cause mortality, microvascular or macrovascular complications of diabetes), especially in participants with diabetes-related complications. No trial reported on socioeconomic effects. AUTHORS' CONCLUSIONS Our analysis found no clear benefits of short-acting insulin analogues over regular human insulin in people with type 2 diabetes. Overall, the certainty of the evidence was poor and results on patient-relevant outcomes, like all-cause mortality, microvascular or macrovascular complications and severe hypoglycaemic episodes were sparse. Long-term efficacy and safety data are needed to draw conclusions about the effects of short-acting insulin analogues on patient-relevant outcomes.
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Affiliation(s)
- Birgit Fullerton
- Goethe UniversityInstitute of General PracticeTheodor‐Stern‐Kai 7Frankfurt am MainGermany60590
| | - Andrea Siebenhofer
- Graz, Austria / Institute of General Practice, Goethe UniversityInstitute of General Practice and Evidence‐Based Health Services Research, Medical University of GrazFrankfurt am MainAustria
| | - Klaus Jeitler
- Medical University of GrazInstitute of General Practice and Evidence‐Based Health Services Research / Institute for Medical Informatics, Statistics and DocumentationAuenbruggerplatz 2/9GrazAustria8036
| | - Karl Horvath
- Medical University of GrazInstitute of General Practice and Evidence‐Based Health Services Research / Department of Internal Medicine, Division of Endocrinology and MetabolismAuenbruggerplatz 2/9GrazAustria8036
| | - Thomas Semlitsch
- Medical University of GrazInstitute of General Practice and Evidence‐Based Health Services ResearchAuenbruggerplatz 2/9GrazAustria8036
| | - Andrea Berghold
- Medical University of GrazInstitute for Medical Informatics, Statistics and DocumentationAuenbruggerplatz 2GrazAustria8036
| | - Ferdinand M Gerlach
- Goethe UniversityInstitute of General PracticeTheodor‐Stern‐Kai 7Frankfurt am MainGermany60590
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Cost-Effectiveness of the Interventions to Avoid Complications and Management in Diabetes Mellitus: A Narrative Review from South-East Asian Perspective. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2018. [DOI: 10.2478/rjdnmd-2018-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and Aims: Asians accounts 60% of the world’s diabetic population with a different burden on young and middle-aged. The objective is to critically evaluate the published literature relevant to cost-effectiveness analysis of interventions to avoid complications followed by the management of diabetes mellitus in South-east Asia. Methods: PubMed, ScienceDirect International Pharmaceutical Abstracts (IPA), Proquest and Google Scholar thoroughly searched within the period of November- December 2015. Only research and reviews published in the English language within the period of January 2000-November 2015 considered. The extracted details and particulars from the included studies account for interventions, outcomes, and modeling methods. Results: A total of seven studies from Japan, Singapore, Cambodia and two each from India and Thailand were included. Incremental cost-effectiveness ratios (ICERs) per quality-adjusted-life-year (QALY) accounted as an outcome in more than half of the reviewed studies. Most of the economic evaluations of DM management and preventive interventions in each country focused on different interventions and alternatives for comparison. However, type 1 DM patients showed better outcome when using specific insulin regimens utilized in the southeastern Asian countries followed by the implementation of Thai DM-self management support program (DM-SMS) via healthcare professionals. Conclusion: Alternatives to pharmacologic approaches such as insulin regimen and oral anti-diabetic agents showed a significant difference
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Nabrdalik K, Kwiendacz H, Sawczyn T, Tomasik A, Kukla M, Masierek M, Gumprecht J. Efficacy, Safety, and Quality of Treatment Satisfaction of Premixed Human and Analogue Insulin Regimens in a Large Cohort of Type 2 Diabetic Patients: PROGENS BENEFIT Observational Study. Int J Endocrinol 2018; 2018:6536178. [PMID: 29755520 PMCID: PMC5884156 DOI: 10.1155/2018/6536178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/14/2018] [Indexed: 11/18/2022] Open
Abstract
Diabetes is a lifelong course disease, so insulin treatment has to be effective and safe, and patients should be satisfied with it. We aimed to compare efficacy, safety, and quality of treatment satisfaction of human and premixed analogue insulin among 3264 patients (53.58% women) with type 2 diabetes mellitus (T2DM) in a real-life environment. 2493 patients (62.77%) had been assigned to group I where before the inclusion into the study the treatment regimen has been changed from analogue to human premixed insulin and 771 patients (37.23%) to group II where the treatment with insulin analogue remained unchanged. At the end of the study, there was a reduction of HbA1c observed in both of the groups; however, Δ HbA1c was significantly higher in group 1 (-0.599 versus -0.406; P < 0.001 at visit 3 versus visit 1). The number of hypoglycemic episodes during the study observation was insignificantly reduced in both groups. Diabetes treatment satisfaction measured with DTSQ increased at the end of the study and was significantly better in group I compared to group II (P < 0.001). This observational study proved that both human and premixed analogue insulin are effective and safe, and patients are satisfied with the treatment.
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Affiliation(s)
- Katarzyna Nabrdalik
- Department of Internal Medicine, Diabetology and Nephrology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Hanna Kwiendacz
- Department of Internal Medicine, Diabetology and Nephrology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Tomasz Sawczyn
- Department of Physiology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Andrzej Tomasik
- Second Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Michał Kukla
- Department of Gastroenterology and Hepatology in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Janusz Gumprecht
- Department of Internal Medicine, Diabetology and Nephrology in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
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Russell‐Jones D, Heller SR, Buchs S, Sandberg A, Valentine WJ, Hunt B. Projected long-term outcomes in patients with type 1 diabetes treated with fast-acting insulin aspart vs conventional insulin aspart in the UK setting. Diabetes Obes Metab 2017; 19:1773-1780. [PMID: 28573681 PMCID: PMC5697732 DOI: 10.1111/dom.13026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/19/2017] [Accepted: 05/29/2017] [Indexed: 11/28/2022]
Abstract
AIM To assess the impact of faster aspart vs insulin aspart on long-term clinical outcomes and costs for patients with type 1 diabetes mellitus (T1DM) in the UK setting. METHODS The QuintilesIMS CORE Diabetes Model was used to project clinical outcomes and costs over patient lifetimes in a cohort with data on baseline characteristics from the "onset 1" trial. Treatment effects were taken from the 26-week main phase of the onset 1 trial, with costs and utilities based on literature review. Future costs and clinical benefits were discounted at 3.5% annually. RESULTS Projections indicated that faster aspart was associated with improved discounted quality-adjusted life expectancy (by 0.13 quality-adjusted life-years) vs insulin aspart. Improved clinical outcomes resulted from fewer diabetes-related complications and a delayed time to their onset with faster aspart. Faster aspart was found to be associated with reduced costs vs insulin aspart (cost savings of £1715), resulting from diabetes-related complications avoided and reduced treatment costs. CONCLUSIONS Faster aspart was associated with improved clinical outcomes and cost savings vs insulin aspart for patients with T1DM in the UK setting.
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Affiliation(s)
- David Russell‐Jones
- Department of Diabetes and Endocrinology, Royal Surrey County HospitalGuildfordUK
| | - Simon R. Heller
- Department of Oncology and Metabolism, University of SheffieldSheffieldUK
| | | | | | | | - Barnaby Hunt
- Ossian Health Economics and CommunicationsBaselSwitzerland
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Misra A, Mukherjee R, Luthra A, Singh P. Rising Costs of Drug/Insulin Treatment for Diabetes: A Perspective from India. Diabetes Technol Ther 2017; 19:693-698. [PMID: 29090974 DOI: 10.1089/dia.2017.0286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Anoop Misra
- 1 National Diabetes, Obesity and Cholesterol Foundation (N-DOC) , SDA, New Delhi, India
- 2 Diabetes Foundation (India) , SDA, New Delhi, India
- 3 Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology , New Delhi, India
| | | | - Atul Luthra
- 3 Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology , New Delhi, India
| | - Padam Singh
- 3 Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology , New Delhi, India
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Dawoud D, Fenu E, Higgins B, Wonderling D, Amiel SA. Basal Insulin Regimens for Adults with Type 1 Diabetes Mellitus: A Cost-Utility Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1279-1287. [PMID: 29241887 DOI: 10.1016/j.jval.2017.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 04/20/2017] [Accepted: 05/21/2017] [Indexed: 06/07/2023]
Abstract
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.
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Affiliation(s)
- Dalia Dawoud
- National Guideline Centre, Royal College of Physicians, London, UK; Clinical Pharmacy Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
| | - Elisabetta Fenu
- National Guideline Centre, Royal College of Physicians, London, UK
| | - Bernard Higgins
- National Guideline Centre, Royal College of Physicians, London, UK
| | - David Wonderling
- National Guideline Centre, Royal College of Physicians, London, UK
| | - Stephanie A Amiel
- Division of Diabetes and Nutritional Sciences and the Diabetes Research Group, Weston Education Centre, King's College London, London, UK
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Marra LP, Araújo VE, Oliveira GC, Diniz LM, Guerra Júnior AA, Acurcio FDA, Godman B, Álvares J. The clinical effectiveness of insulin glargine in patients with Type I diabetes in Brazil: findings and implications. J Comp Eff Res 2017; 6:519-527. [PMID: 28960085 DOI: 10.2217/cer-2016-0099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
AIM Published studies have challenged the cost-effectiveness of insulin glargine versus neutral protamine hagedorn (NPH) insulins in Brazil with limited evidence of increased effectiveness despite considerably higher acquisition costs. However, still a controversy. Consequently, there is a need to address this. MATERIALS & METHODS Retrospective cohort study of Type I diabetes patients receiving insulin glargine in Brazil following NPH insulin who met the criteria. RESULTS 580 patients were enrolled. HbA1c varied from 8.80 ± 1.98% in NPH insulin users to 8.54 ± 1.88% after insulin glargine for 6 months, which is not clinically significant. Frequency of glycemic control varied from 22.6% with NPH insulin to 26.2% with insulin glargine. No statistically significant difference was observed between controlled and still uncontrolled groups for all analyzed factors including type and frequency of insulin use and carbohydrate counting. CONCLUSION Limited differences between NPH insulins and insulin analogs in routine clinical care do not justify an appreciable cost difference.
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Affiliation(s)
- Lays P Marra
- Department of Social Pharmacy, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Vânia E Araújo
- Department of Social Pharmacy, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Gerusa Cc Oliveira
- Department of Social Pharmacy, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Leonardo M Diniz
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Augusto A Guerra Júnior
- Department of Social Pharmacy, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,SUS Collaborating Centre - Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Francisco de Assis Acurcio
- Department of Social Pharmacy, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.,SUS Collaborating Centre - Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Health Economics Centre, Liverpool University Management School, Liverpool University, UK
| | - Juliana Álvares
- Department of Social Pharmacy, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,SUS Collaborating Centre - Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
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Torres DR, Portilla A, Machado-Duque ME, Machado-Alba JE. Trends in the use and cost of human and analogue insulins in a Colombian population, 2011-2015. Public Health 2017; 153:64-69. [PMID: 28950114 DOI: 10.1016/j.puhe.2017.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/19/2017] [Accepted: 08/21/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Diabetes mellitus is a common disease among the general population and imposes considerable costs on health care systems. Insulin is used to treat type 1 diabetes mellitus and as an adjuvant to oral agents in advanced stages of type 2 diabetes mellitus. The objective was to describe the trends in use and cost of human and analogue insulins for Colombian patients. STUDY DESIGN Descriptive retrospective analysis of prescriptions of human and analogue insulins on a monthly basis for the period from July 1, 2011 to February 2, 2015. METHODS Information was collected for the database population of two insurance companies. Frequencies and proportions were calculated; estimated economic impact was expressed as net cost and cost per thousand inhabitants per day. RESULTS During the observation period, there was continuous growth in use of insulin, mainly in analogue forms (34.0% growth). At the start of the study, 10.4% of subjects were using an analogue insulin; this figure was 62.6% at the end of the study. In 2012, the average cost per 1000 inhabitants/day was US$1.7 for analogue and US$0.8 for human insulins. At the end of the observation period these costs had risen to US$9.2 for analogue (441.1% increase) and fallen to US$0.5 for human insulin (58.3% decrease). CONCLUSIONS There has been an increase in the unit cost and frequency of use of insulin analogues for anti-diabetic therapy in Colombian patients. Moreover, there is controversy over whether insulin analogues are a more cost-effective treatment than human insulins for the general diabetic population.
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Affiliation(s)
- D R Torres
- Gerencia de Farmacoepidemiología Audifarma S.A, Colombia
| | - A Portilla
- Gerencia de Farmacoepidemiología Audifarma S.A, Colombia
| | - M E Machado-Duque
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Colombia
| | - J E Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Colombia.
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Hunt B, Vega-Hernandez G, Valentine WJ, Kragh N. Evaluation of the long-term cost-effectiveness of liraglutide vs lixisenatide for treatment of type 2 diabetes mellitus in the UK setting. Diabetes Obes Metab 2017; 19:842-849. [PMID: 28124820 DOI: 10.1111/dom.12890] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/16/2017] [Accepted: 01/20/2017] [Indexed: 12/20/2022]
Abstract
AIMS To compare the cost-effectiveness of 2 glucagon-like peptide-1 (GLP-1) receptor agonists, liraglutide 1.8 mg and lixisenatide 20 µg, in the UK setting based on the LIRA-LIXI trial (NCT01973231). MATERIALS AND METHODS Projections of costs (in 2015 pounds sterling [£]) and clinical outcomes were made over patient lifetimes using the IMS CORE Diabetes Model (IMS Health, Basel, Switzerland). The baseline cohort and treatment effects applied after initiation of GLP-1 receptor agonists were taken from the LIRA-LIXI trial. Future costs and clinical benefits were discounted at 3.5% annually. RESULTS Liraglutide 1.8 mg was associated with improved discounted quality-adjusted life expectancy (8.87 vs 8.76 quality-adjusted life years [QALYs]) vs lixisenatide 20 µg. A greater reduction in glycated haemoglobin with liraglutide 1.8 mg led to fewer diabetes-related complications and delayed their time of onset. Liraglutide 1.8 mg was associated with increased total costs (£37 153 vs £36 174), driven by higher acquisition costs, but this was partially offset by savings from diabetes-related complications avoided (£26 969 vs £27 912). Liraglutide 1.8 mg was associated with an incremental cost-effectiveness ratio of £8901 per QALY gained vs lixisenatide 20 µg. CONCLUSIONS Long-term projections suggest that treatment of patients with type 2 diabetes with liraglutide 1.8 mg is likely to be considered highly cost-effective compared with lixisenatide 20 µg treatment in the UK setting.
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Affiliation(s)
- Barnaby Hunt
- Ossian Health Economics and Communications, Basel, Switzerland
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Vega-Hernandez G, Wojcik R, Schlueter M. Cost-Effectiveness of Liraglutide Versus Dapagliflozin for the Treatment of Patients with Type 2 Diabetes Mellitus in the UK. Diabetes Ther 2017; 8:513-530. [PMID: 28349443 PMCID: PMC5446377 DOI: 10.1007/s13300-017-0250-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION To date there is a lack of economic analysis comparing glucagon-like peptide-1 receptor agonists (GLP-1RAs) to sodium-glucose co-transporter 2 inhibitors (SGLT-2i) for the treatment of type 2 diabetes mellitus (T2DM). Liraglutide and dapagliflozin are the most commonly prescribed GLP-1RA and SGLT-2i in the UK. This analysis investigated the cost-effectiveness of liraglutide 1.2 and 1.8 mg/day compared to dapagliflozin 10 mg/day for the treatment of T2DM in the UK in patients on dual and triple antidiabetic therapy. METHODS Cost-effectiveness analysis was conducted in the QuintilesIMS CORE Diabetes Model (CDM). The model estimated expected costs and outcomes over a lifetime horizon using the UK national payer perspective. Liraglutide efficacy estimates and patient characteristics were sourced from a trial in patients on prior metformin monotherapy, and from a trial in patients on prior combination therapy. Comparative efficacy data for the other interventions were derived from a network meta-analysis. Utility inputs were extracted from a systematic literature review. Costs are presented in Great British Pound (GBP), 2016 values. RESULTS In dual and triple therapy, liraglutide 1.2 mg was less costly and more effective compared with dapagliflozin 10 mg, providing a QALY gain of 0.04 and cost savings of GBP 11 per patient in dual therapy, and a QALY gain of 0.06 and cost savings of GBP 71 per patient in triple therapy. For liraglutide 1.8 mg, increased efficacy and costs compared with dapagliflozin 10 mg were observed in both dual and triple therapy. In dual therapy, a QALY gain of 0.07 and additional costs of GBP 888 per patient yielded an ICER of GBP 13,227, whereas in triple therapy a QALY gain of 0.07 and additional cost of GBP 791 per patient gave an ICER of 11,857. CONCLUSION This long-term modelling analysis found that both dosages of liraglutide may be cost-effective treatment alternatives as part of a dual or a triple antidiabetic therapy in patients for whom an SGLT-2i therapy is considered. FUNDING Novo Nordisk.
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Curington R, Espel M, Heaton PC, Luder H, Brown B. Clinical outcomes of switching from insulin glargine to NPH insulin in indigent patients at a charitable pharmacy: The Charitable Insulin NPH: Care for the Indigent study. J Am Pharm Assoc (2003) 2017; 57:S229-S235. [PMID: 28366602 DOI: 10.1016/j.japh.2017.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/27/2017] [Accepted: 02/09/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To assess the clinical outcomes of indigent patients with type 2 diabetes served by a charitable pharmacy after therapy change from insulin glargine to NPH insulin. DESIGN This was a 24-week prospective pilot study. SETTING Community charitable pharmacy. PARTICIPANTS Underserved, financially disadvantaged adults with type 2 diabetes. INTERVENTION Conversion from insulin glargine to NPH insulin. MAIN OUTCOME MEASURES HbA1c, 30-day average blood glucose, number of suspected and confirmed hypoglycemic episodes, total insulin dose, and Morisky Medication Adherence Scale (MMAS) scores. RESULTS Patients in both control and intervention groups improved in disease-state clinical markers, safety profile, and total insulin dose. MMAS scores were unchanged. CONCLUSION There were no statistically significant differences in glycemic control or hypoglycemic episodes between the control (NPH insulin) or intervention group (insulin glargine to NPH insulin).
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Fortwaengler K, Parkin CG, Neeser K, Neumann M, Mast O. Description of a New Predictive Modeling Approach That Correlates the Risk and Associated Cost of Well-Defined Diabetes-Related Complications With Changes in Glycated Hemoglobin (HbA1c). J Diabetes Sci Technol 2017; 11:315-323. [PMID: 27510441 PMCID: PMC5478016 DOI: 10.1177/1932296816662048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The modeling approach described here is designed to support the development of spreadsheet-based simple predictive models. It is based on 3 pillars: association of the complications with HbA1c changes, incidence of the complications, and average cost per event of the complication. For each pillar, the goal of the analysis was (1) to find results for a large diversity of populations with a focus on countries/regions, diabetes type, age, diabetes duration, baseline HbA1c value, and gender; (2) to assess the range of incidences and associations previously reported. Unlike simple predictive models, which mostly are based on only 1 source of information for each of the pillars, we conducted a comprehensive, systematic literature review. Each source found was thoroughly reviewed and only sources meeting quality expectations were considered. The approach allows avoidance of unintended use of extreme data. The user can utilize (1) one of the found sources, (2) the found range as validation for the found figures, or (3) the average of all found publications for an expedited estimate. The modeling approach is intended for use in average insulin-treated diabetes populations in which the baseline HbA1c values are within an average range (6.5% to 11.5%); it is not intended for use in individuals or unique diabetes populations (eg, gestational diabetes). Because the modeling approach only considers diabetes-related complications that are positively associated with HbA1c decreases, the costs of negatively associated complications (eg, severe hypoglycemic events) must be calculated separately.
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Affiliation(s)
| | - Christopher G. Parkin
- CGParkin Communications, Inc, Boulder City, USA
- Christopher G. Parkin, MS, CGParkin Communications, Inc, 219 Red Rock Rd, Boulder City, Nevada 89005, USA.
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Hua X, Lung TWC, Palmer A, Si L, Herman WH, Clarke P. How Consistent is the Relationship between Improved Glucose Control and Modelled Health Outcomes for People with Type 2 Diabetes Mellitus? a Systematic Review. PHARMACOECONOMICS 2017; 35:319-329. [PMID: 27873225 PMCID: PMC5306373 DOI: 10.1007/s40273-016-0466-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND There are an increasing number of studies using simulation models to conduct cost-effectiveness analyses for type 2 diabetes mellitus. OBJECTIVE To evaluate the relationship between improvements in glycosylated haemoglobin (HbA1c) and simulated health outcomes in type 2 diabetes cost-effectiveness studies. METHODS A systematic review was conducted on MEDLINE and EMBASE to collect cost-effectiveness studies using type 2 diabetes simulation models that reported modelled health outcomes of blood glucose-related interventions in terms of quality-adjusted life-years (QALYs) or life expectancy (LE). The data extracted included information used to characterise the study cohort, the intervention's treatment effects on risk factors and model outcomes. Linear regressions were used to test the relationship between the difference in HbA1c (∆HbA1c) and incremental QALYs (∆QALYs) or LE (∆LE) of intervention and control groups. The ratio between the ∆QALYs and ∆LE was calculated and a scatterplot between the ratio and ∆HbA1c was used to explore the relationship between these two. RESULTS Seventy-six studies were included in this research, contributing to 124 pair of comparators. The pooled regressions indicated that the marginal effect of a 1% HbA1c decrease in intervention resulted in an increase in life-time QALYs and LE of 0.371 (95% confidence interval 0.286-0.456) and 0.642 (95% CI 0.494-0.790), respectively. No evidence of heterogeneity between models was found. An inverse exponential relationship was found and fitted between the ratio (∆QALY/∆LE) and ∆HbA1c. CONCLUSION There is a consistent relationship between ∆HbA1c and ∆QALYs or ∆LE in cost-effectiveness analyses using type 2 diabetes simulation models. This relationship can be used as a diagnostic tool for decision makers.
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Affiliation(s)
- Xinyang Hua
- School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Thomas Wai-Chun Lung
- School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3053, Australia
- The George Institute for Global Health, University of Sydney, Lidcombe, NSW, Australia
| | - Andrew Palmer
- Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia
| | - Lei Si
- Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia
| | - William H Herman
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Philip Clarke
- School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
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Hunt B, Ye Q, Valentine WJ, Ashley D. Evaluating the Long-Term Cost-Effectiveness of Daily Administered GLP-1 Receptor Agonists for the Treatment of Type 2 Diabetes in the United Kingdom. Diabetes Ther 2017; 8:129-147. [PMID: 28058656 PMCID: PMC5306118 DOI: 10.1007/s13300-016-0219-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The glucagon-like peptide-1 (GLP-1) receptor agonist class has grown in the last decade, with several agents available in the UK. However there is currently a paucity of evidence regarding the relative cost-effectiveness of liraglutide 1.2 mg versus other daily administered GLP-1 receptor agonists, due to a lack of head-to-head trial data. Therefore the present analysis was performed, using results from a network meta-analysis (NMA), to compare the cost-effectiveness of three currently available daily administered GLP-1 receptor agonists for treatment of diabetes in the UK setting. METHODS A validated and published diabetes model was used to make long-term projections of clinical outcomes and direct costs (2015 GBP) for patients receiving liraglutide 1.2 mg once-daily, exenatide 10 μg twice daily and lixisenatide 20 μg once-daily. Treatment effects were taken from an NMA evaluating the efficacy of GLP-1 receptor agonists and were applied in a cohort based on the Liraglutide Effect and Action in Diabetes 6 (LEAD-6) trial. Costs and utilities were based on published sources. RESULTS Liraglutide 1.2 mg was associated with improved quality-adjusted life expectancy versus exenatide [9.19 versus 9.17 quality-adjusted life years (QALYs)] and lixisenatide (9.19 versus 9.12 QALYs). Improvements were driven by benefits in glycemic control, leading to a reduced incidence of diabetes-related complications. Liraglutide 1.2 mg was associated with reduced costs versus exenatide (GBP 36,394 versus GBP 36,547) and lixisenatide (GBP 36,394 versus GBP 36,496), with cost savings as a result of complications avoided entirely offsetting increased acquisition costs. Based on the projected outcomes, liraglutide was found to be dominant over both exenatide and lixisenatide. CONCLUSION Liraglutide 1.2 mg is likely to be considered cost-effective versus alternative daily administered GLP-1 receptor agonists for treatment of type 2 diabetes in the UK.
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Affiliation(s)
- Barnaby Hunt
- Ossian Health Economics and Communications, Basel, Switzerland
| | - Qing Ye
- Novo Nordisk A/S, Søborg, Denmark
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Shafie AA, Ng CH, Tan YP, Chaiyakunapruk N. Systematic Review of the Cost Effectiveness of Insulin Analogues in Type 1 and Type 2 Diabetes Mellitus. PHARMACOECONOMICS 2017; 35:141-162. [PMID: 27752998 DOI: 10.1007/s40273-016-0456-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Insulin analogues have a pharmacokinetic advantage over human insulin and are increasingly used to treat diabetes mellitus. A summary of their cost effectiveness versus other available treatments was required. OBJECTIVE Our objective was to systematically review the published cost-effectiveness studies of insulin analogues for the treatment of patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). METHODS We searched major databases and health technology assessment agency reports for economic evaluation studies published up until 30 September 2015. Two reviewers performed data extraction and assessed the quality of the data using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. RESULTS Seven of the included studies assessed short-acting insulin analogues, 12 assessed biphasic insulin analogues, 30 assessed long-acting insulin analogues and one assessed a combination of short- and long-acting insulin analogues. Only 17 studies involved patients with T1DM, all were modelling studies and 12 were conducted in Canada. The incremental cost-effectiveness ratios (ICERs) for short-acting insulin analogues ranged from dominant to $US435,913 per quality-adjusted life-year (QALY) gained, the ICERs for biphasic insulin analogues ranged from dominant to $US57,636 per QALY gained and the ICERs for long-acting insulin analogues ranged from dominant to $US599,863 per QALY gained. A total of 15 studies met all the CHEERS guidelines reporting quality criteria. Only 26 % of the studies assessed heterogeneity in their analyses. CONCLUSION Current evidence indicates that insulin analogues are cost effective for T1DM; however, evidence for their use in T2DM is not convincing. Additional evidence regarding compliance and efficacy is required to support the broader use of long-acting and biphasic insulin analogues in T2DM. The value of insulin analogues depends strongly on reductions in hypoglycaemia event rates and its efficacy in lowering glycated haemoglobin (HbA1c).
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Affiliation(s)
- Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), 11800, Penang, Malaysia.
| | - Chin Hui Ng
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), 11800, Penang, Malaysia
| | - Yui Ping Tan
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), 11800, Penang, Malaysia
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research (CPOR), Naresuan University, Phitsanulok, Thailand
- School of Pharmacy, University of Wisconsin, Madison, WI, USA
- School of Population Health, University of Queensland, Brisbane, QLD, Australia
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Fullerton B, Siebenhofer A, Jeitler K, Horvath K, Semlitsch T, Berghold A, Plank J, Pieber TR, Gerlach FM. Short-acting insulin analogues versus regular human insulin for adults with type 1 diabetes mellitus. Cochrane Database Syst Rev 2016; 2016:CD012161. [PMID: 27362975 PMCID: PMC6597145 DOI: 10.1002/14651858.cd012161] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Short-acting insulin analogue use for people with diabetes is still controversial, as reflected in many scientific debates. OBJECTIVES To assess the effects of short-acting insulin analogues versus regular human insulin in adults with type 1 diabetes. SEARCH METHODS We carried out the electronic searches through Ovid simultaneously searching the following databases: Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R) (1946 to 14 April 2015), EMBASE (1988 to 2015, week 15), the Cochrane Central Register of Controlled Trials (CENTRAL; March 2015), ClinicalTrials.gov and the European (EU) Clinical Trials register (both March 2015). SELECTION CRITERIA We included all randomised controlled trials with an intervention duration of at least 24 weeks that compared short-acting insulin analogues with regular human insulins in the treatment of adults with type 1 diabetes who were not pregnant. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed trials for risk of bias, and resolved differences by consensus. We graded overall study quality using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) instrument. We used random-effects models for the main analyses and presented the results as odds ratios (OR) with 95% confidence intervals (CI) for dichotomous outcomes. MAIN RESULTS We identified nine trials that fulfilled the inclusion criteria including 2693 participants. The duration of interventions ranged from 24 to 52 weeks with a mean of about 37 weeks. The participants showed some diversity, mainly with regard to diabetes duration and inclusion/exclusion criteria. The majority of the trials were carried out in the 1990s and participants were recruited from Europe, North America, Africa and Asia. None of the trials was carried out in a blinded manner so that the risk of performance bias, especially for subjective outcomes such as hypoglycaemia, was present in all of the trials. Furthermore, several trials showed inconsistencies in the reporting of methods and results.The mean difference (MD) in glycosylated haemoglobin A1c (HbA1c) was -0.15% (95% CI -0.2% to -0.1%; P value < 0.00001; 2608 participants; 9 trials; low quality evidence) in favour of insulin analogues. The comparison of the risk of severe hypoglycaemia between the two treatment groups showed an OR of 0.89 (95% CI 0.71 to 1.12; P value = 0.31; 2459 participants; 7 trials; very low quality evidence). For overall hypoglycaemia, also taking into account mild forms of hypoglycaemia, the data were generally of low quality, but also did not indicate substantial group differences. Regarding nocturnal severe hypoglycaemic episodes, two trials reported statistically significant effects in favour of the insulin analogue, insulin aspart. However, due to inconsistent reporting in publications and trial reports, the validity of the result remains questionable.We also found no clear evidence for a substantial effect of insulin analogues on health-related quality of life. However, there were few results only based on subgroups of the trial populations. None of the trials reported substantial effects regarding weight gain or any other adverse events. No trial was designed to investigate possible long-term effects (such as all-cause mortality, diabetic complications), in particular in people with diabetes related complications. AUTHORS' CONCLUSIONS Our analysis suggests only a minor benefit of short-acting insulin analogues on blood glucose control in people with type 1 diabetes. To make conclusions about the effect of short acting insulin analogues on long-term patient-relevant outcomes, long-term efficacy and safety data are needed.
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Affiliation(s)
- Birgit Fullerton
- Goethe UniversityInstitute of General PracticeTheodor‐Stern‐Kai 7Frankfurt am MainHesseGermany60590
| | - Andrea Siebenhofer
- Graz, Austria / Institute of General Practice, Goethe UniversityInstitute of General Practice and Evidence‐Based Health Services Research, Medical University of GrazFrankfurt am MainAustria
| | - Klaus Jeitler
- Medical University of GrazInstitute of General Practice and Evidence‐Based Health Services Research / Institute for Medical Informatics, Statistics and DocumentationAuenbruggerplatz 2/9GrazAustria8036
| | - Karl Horvath
- Medical University of GrazInstitute of General Practice and Evidence‐Based Health Services Research / Department of Internal Medicine, Division of Endocrinology and MetabolismAuenbruggerplatz 2/9GrazAustria8036
| | - Thomas Semlitsch
- Medical University of GrazInstitute of General Practice and Evidence‐Based Health Services ResearchAuenbruggerplatz 2/9GrazAustria8036
| | - Andrea Berghold
- Medical University of GrazInstitute for Medical Informatics, Statistics and DocumentationAuenbruggerplatz 2GrazAustria8036
| | - Johannes Plank
- Medical University of GrazDepartment of Internal MedicineAuenbruggerplatz 15GrazAustria8036
| | - Thomas R Pieber
- Medical University of GrazDepartment of Internal MedicineAuenbruggerplatz 15GrazAustria8036
| | - Ferdinand M Gerlach
- Goethe UniversityInstitute of General PracticeTheodor‐Stern‐Kai 7Frankfurt am MainHesseGermany60590
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Brown S, Al Hamarneh YN, Tsuyuki RT, Nehme K, Sauriol L. Economic analysis of insulin initiation by pharmacists in a Canadian setting: The RxING study. Can Pharm J (Ott) 2016; 149:130-7. [PMID: 27212963 DOI: 10.1177/1715163516640813] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Conducted in Alberta, the RxING study examined the effect of a community pharmacist prescribing intervention on glycemic control in patients with uncontrolled type 2 diabetes mellitus (T2DM) using insulin glargine. The objective of this study was to assess the cost-effectiveness of pharmacists' prescribing of insulin glargine as an early intervention in uncontrolled patients with T2DM vs usual clinical practice. METHODS The IMS CORE diabetes Markov model was used to project long-term clinical outcomes, costs and cost-effectiveness of interventions. The efficacy of insulin glargine, in terms of hemoglobin A1c reduction and hypoglycemia rates, was obtained from the RxING study. Health utility and cost data were found in Canadian publications. The base-case analyses examined the economic and clinical effects of having pharmacists initiate insulin therapy in patients with uncontrolled T2DM in comparison to a physician initiate it up to 3 years later. RESULTS Insulin initiation by pharmacists with uncontrolled T2DM patients is cost-effective. Having pharmacists prescribe insulin 1 year earlier than usual clinical practice resulted in an incremental cost savings of $805 (CDN$) and a gain of 0.048 QALYs per patient. Pharmacists prescribing insulin 2 years earlier resulted in an incremental cost savings of $624 (CDN$) per year and a gain of 0.075 quality-adjusted life-years (QALYs). Prescribing 3 years earlier allowed for a minor increase of $26 and a gain of 0.086 QALYs. CONCLUSION Earlier initiation of insulin by pharmacists, in uncontrolled T2DM patients, resulted in cost savings and delays in the development of diabetes-related complications, leading to an improved quality of life and increased survival rates.
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Affiliation(s)
- Stephen Brown
- Cornerstone Research Group Inc. (Brown), Burlington, Ontario
| | | | - Ross T Tsuyuki
- Cornerstone Research Group Inc. (Brown), Burlington, Ontario
| | - Kimberley Nehme
- Cornerstone Research Group Inc. (Brown), Burlington, Ontario
| | - Luc Sauriol
- Cornerstone Research Group Inc. (Brown), Burlington, Ontario
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Ena J, Gómez-Huelgas R, Sánchez-Fuentes D, Camafort-Babkowsk M, Formiga F, Michán-Doña A, Casariego E. Management of patients with type 2 diabetes and multiple chronic conditions: A Delphi consensus of the Spanish Society of Internal Medicine. Eur J Intern Med 2016; 27:31-6. [PMID: 26586286 DOI: 10.1016/j.ejim.2015.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/28/2015] [Accepted: 10/19/2015] [Indexed: 02/07/2023]
Abstract
AIMS To develop consensus-based recommendations for the management of chronic complex patients with type 2 diabetes mellitus using a two round Delphi technique. METHODS Experts from the Diabetes and Obesity Working Group (DOWG) of the Spanish Society of Internal Medicine (SEMI) reviewed MEDLINE, PubMed, SCOPUS and Cochrane Library databases up to September 2014 to gather information on organization and health care management, stratification of therapeutic targets and therapeutic approach for glucose control in chronic complex patients with type 2 diabetes mellitus. A list of 6 recommendations was created and rated by a panel of 75 experts from the DOWG by email (first round) and by open discussion (second round). A written document was produced and sent back to DOWG experts for clarification purposes. RESULTS A high degree of consensus was achieved for all recommendations summarized as 1) there is a need to redesign and test new health care programs for chronic complex patients with type 2 diabetes mellitus; 2) therapeutic targets in patients with short life expectancy should be individualized in accordance to their personal, clinical and social characteristics; 3) patients with chronic complex conditions and type 2 diabetes mellitus should be stratified by hypoglycemia risk; 4) age and specific comorbidities should guide the objectives for glucose control; 5) the risk of hypoglycemia should be a key factor when choosing a treatment; and 6) basal insulin analogs compared to human insulin are cost-effective options. CONCLUSION The assessment and recommendations provided herein represent our best professional judgment based on current data and clinical experience.
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Affiliation(s)
- Javier Ena
- Internal Medicine Department, Hospital Marina Baixa, Alicante, Spain.
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Hospital Regional Universitario, FIMABIS, Málaga, Spain
| | | | - Miguel Camafort-Babkowsk
- Geriatric Unit, Internal Medicine Department, Hospital Clínic, University of Barcelona, "August Pi i Sunyer" Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Francesc Formiga
- Geriatric Unit, Internal Medicine Department, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
| | - Alfredo Michán-Doña
- Internal Medicina Deparment, Hospital de Jerez de la Frontera, Universidad de Cádiz, Cádiz, Spain
| | - Emilio Casariego
- Internal Medicine Department, Hospital Lucus Augustis, Lugo, Spain
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Roze S, Smith-Palmer J, Valentine WJ, Cook M, Jethwa M, de Portu S, Pickup JC. Long-term health economic benefits of sensor-augmented pump therapy vs continuous subcutaneous insulin infusion alone in type 1 diabetes: a U.K. perspective. J Med Econ 2016; 19:236-42. [PMID: 26510389 DOI: 10.3111/13696998.2015.1113979] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIMS/HYPOTHESIS Continuous subcutaneous insulin infusion (CSII) is an important treatment option for type 1 diabetes patients unable to achieve adequate glycemic control with multiple daily injections (MDI). Combining CSII with continuous glucose monitoring (CGM) in sensor-augmented pump therapy (SAP) with a low glucose-suspend (LGS) feature may further improve glycemic control and reduce the frequency of hypoglycemia. A cost-effectiveness analysis of SAP + LGS vs. CSII plus self-monitoring of blood glucose (SMBG) was performed to determine the health economic benefits of SAP + LGS in type 1 diabetes patients using CSII in the U.K. METHODS Cost-effectiveness analysis was performed using the CORE diabetes model. Treatment effects were sourced from the literature, where SAP + LGS was associated with a projected HbA1c reduction of -1.49% vs. -0.62% for CSII, and a reduced frequency of severe hypoglycemia. The time horizon was that of patient lifetimes; future costs and clinical outcomes were discounted at 3.5% and 1.5% per annum, respectively. RESULTS Projected outcomes showed that SAP + LGS was associated with higher mean quality-adjusted life expectancy (17.9 vs. 14.9 quality-adjusted life years [QALYs], SAP + LGS vs. CSII), and higher life expectancy (23.8 vs. 21.9 years), but higher mean lifetime direct costs (GBP 125,559 vs. GBP 88,991), leading to an incremental cost-effectiveness ratio (ICER) of GBP 12,233 per QALY gained for SAP + LGS vs. CSII. Findings of the base-case analysis remained robust in sensitivity analyses. CONCLUSIONS/INTERPRETATION For UK-based type 1 diabetes patients with poor glycemic control, the use of SAP + LGS is likely to be cost-effective compared with CSII plus SMBG.
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Affiliation(s)
| | | | | | | | | | - Simona de Portu
- d d Medtronic International Trading Sàrl , Tolochenaz , Switzerland
| | - John C Pickup
- e e Faculty of Life Sciences and Medicine , King's College London, Guy's Hospital , London , UK
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Svensson AM, Lak V, Fard MP, Eliasson B. Total costs of basal or premixed insulin treatment in 5077 insulin-naïve type 2 diabetes patients: register-based observational study in clinical practice. Clin Diabetes Endocrinol 2015; 1:17. [PMID: 28702235 PMCID: PMC5471692 DOI: 10.1186/s40842-015-0017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/28/2015] [Indexed: 11/10/2022] Open
Abstract
Background To investigate the costs of treatment with basal insulin (insulin NPH [NPH], insulin glargine [IG], insulin determir [IG]), and premixed insulin (PM) in routine clinical care. Methods Cohort study based on data from the Swedish National Diabetes Register, including 5077 insulin-naïve men and women with type 2 diabetes, resident in a distinct geographical region of Sweden. Patients were included between 1 July 2006 and 31 December 2009 and followed for 12 months. All drug- and healthcare-related costs, stratified by diabetes-related or non-diabetes care contacts, were quantified and compared to baseline. Results Initiation of insulin treatment generally entails increased diabetes-related health care contacts and treatment costs, and decrease in health care costs. The median changes in costs were generally smaller than the mean changes, reflecting great variations between patients. The treatment costs were higher for IG, ID and PM compared with NPH, although higher age, history cardiovascular disease and diabetes complications as well as higher diabetes-related and other treatment costs were independent predictors. Overall, only PM (but not IG or ID) were associated with higher diabetes-related health care costs, although these were also independently predicted by cardiovascular morbidity and markers of complicated diabetes. Conclusions This study demonstrates that the initiation of insulin in patients with type 2 diabetes in clinical practice leads to increased health care contacts, overall and treatment costs, but also generally results in a decrease in health care costs. The diabetes-related treatment cost was lowest using NPH insulin but only premixed insulin was associated with higher diabetes-related health care costs than NPH. Electronic supplementary material The online version of this article (doi:10.1186/s40842-015-0017-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Vincent Lak
- Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, S-413 45 Göteborg, Sweden
| | | | - Björn Eliasson
- Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, S-413 45 Göteborg, Sweden
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Cheung KKT, Senior PA. Novel and Emerging Insulin Preparations for Type 2 Diabetes. Can J Diabetes 2015; 39 Suppl 5:S160-6. [DOI: 10.1016/j.jcjd.2015.09.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 09/18/2015] [Accepted: 09/23/2015] [Indexed: 11/26/2022]
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Wang S, Yang Z, Gao Y, Li Q, Su Y, Wang Y, Zhang Y, Man H, Liu H. Pyruvate kinase, muscle isoform 2 promotes proliferation and insulin secretion of pancreatic β-cells via activating Wnt/CTNNB1 signaling. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:14441-8. [PMID: 26823761 PMCID: PMC4713547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/25/2015] [Indexed: 06/05/2023]
Abstract
Failure of pancreatic β-cells is closely associated with type 2 diabetes mellitus (T2DM), an intractable disease affecting numerous patients. Pyruvate kinase, muscle isoform 2 (PKM2) is a potential modulator of insulin secretion in β-cells. This study aims at revealing roles and possible mechanisms of PKM2 in pancreatic β-cells. Mouse pancreatic β-cell line NIT-1 was used for high glucose treatment and PKM2 overexpression by its specific expression vector. Cell proliferation by Thiazolyl blue assay, cell apoptosis by annexin V-fluorescein isothiocyanate/prodium iodide staining and insulin secretion assay by ELISA were performed in each group. The mRNA and protein levels of related factors were analyzed by real-time quantitative PCR and western blot. Results showed that Pkm2 was inhibited under high glucose conditions compared to the untreated cells (P < 0.01). Its overexpression significantly suppressed NIT-1 cell apoptosis (P < 0.01), and induced cell proliferation (P < 0.05) and insulin secretion (P < 0.05). Related factors showed consistent mRNA expression changes. Protein levels of β-catenin (CTNNB1), insulin receptor substrate 1 (IRS1) and IRS2 were all promoted by PKM2 overexpression (P < 0.01), indicating the activated Wnt/CTNNB1 signaling. These results indicated the inductive roles of PKM2 in pancreatic β-cell NIT-1, including promoting cell proliferation and insulin secretion, and inhibiting cell apoptosis, which might be achieved via activating the Wnt/CTNNB1 signaling and downstream factors. This study offers basic information on the role and mechanism of PKM2 in pancreatic β-cells, and lays the foundation for using PKM2 as a potential therapeutic target in T2DM.
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Affiliation(s)
- Suijun Wang
- Department of Endocrinology and Metabolism, Henan Provincial People’s Hospital, Zhengzhou UniversityZhengzhou 450003, P. R. China
| | - Zhen Yang
- Department of Endocrinology and Metabolism, Xinhua Hospital, Shanghai Jiaotong University School of MedicineShanghai 200092, P. R. China
| | - Ying Gao
- Neonatal Intensive Care Unit, Henan Provincial People’s Hospital, Zhengzhou UniversityZhengzhou 450003, P. R. China
| | - Quanzhong Li
- Department of Endocrinology and Metabolism, Henan Provincial People’s Hospital, Zhengzhou UniversityZhengzhou 450003, P. R. China
| | - Yong Su
- Department of Endocrinology and Metabolism, Henan Provincial People’s Hospital, Zhengzhou UniversityZhengzhou 450003, P. R. China
| | - Yanfang Wang
- Department of Endocrinology and Metabolism, Henan Provincial People’s Hospital, Zhengzhou UniversityZhengzhou 450003, P. R. China
| | - Yun Zhang
- Department of Endocrinology and Metabolism, Henan Provincial People’s Hospital, Zhengzhou UniversityZhengzhou 450003, P. R. China
| | - Hua Man
- Department of Endocrinology and Metabolism, Henan Provincial People’s Hospital, Zhengzhou UniversityZhengzhou 450003, P. R. China
| | - Hongxia Liu
- Department of Endocrinology and Metabolism, Henan Provincial People’s Hospital, Zhengzhou UniversityZhengzhou 450003, P. R. China
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Nuevas insulinas en la diabetes tipo 1. Med Clin (Barc) 2015; 145:70-5. [DOI: 10.1016/j.medcli.2014.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/10/2014] [Indexed: 11/16/2022]
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Khazrai YM, Buzzetti R, Del Prato S, Cahn A, Raz I, Pozzilli P. The addition of E (Empowerment and Economics) to the ABCD algorithm in diabetes care. J Diabetes Complications 2015; 29:599-606. [PMID: 25795559 DOI: 10.1016/j.jdiacomp.2015.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 02/05/2015] [Accepted: 03/01/2015] [Indexed: 12/22/2022]
Abstract
The ABCD (Age, Body weight, Complications, Duration of disease) algorithm was proposed as a simple and practical tool to manage patients with type 2 diabetes. Diabetes treatment, as for all chronic diseases, relies on patients' ability to cope with daily problems concerning the management of their disease in accordance with medical recommendations. Thus, it is important that patients learn to manage and cope with their disease and gain greater control over actions and decisions affecting their health. Healthcare professionals should aim to encourage and increase patients' perception about their ability to take informed decisions about disease management and to improve patient self-esteem and feeling of self-efficacy to become agents of their own health. E for Empowerment is therefore an additional factor to take into account in the management of patients with type 2 diabetes. E stands also for Economics to be considered in diabetes care. Attention should be paid to public health policies as well as to the physician faced with the dilemma of delivering the best possible care within the problem of limited resources. The financial impact of the new treatment modalities for diabetes represents an issue that needs to be addressed at multiple strata both globally and nationally.
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Affiliation(s)
| | | | | | - Avivit Cahn
- Department of Internal Medicine, Hadassah University Hospital, Jerusalem, Israel
| | - Itamar Raz
- Department of Internal Medicine, Hadassah University Hospital, Jerusalem, Israel
| | - Paolo Pozzilli
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy; Centre of Diabetes, St. Bartholomew's and The London School of Medicine, Queen Mary, University of London, UK.
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Tricco AC, Ashoor HM, Antony J, Beyene J, Veroniki AA, Isaranuwatchai W, Harrington A, Wilson C, Tsouros S, Soobiah C, Yu CH, Hutton B, Hoch JS, Hemmelgarn BR, Moher D, Majumdar SR, Straus SE. Safety, effectiveness, and cost effectiveness of long acting versus intermediate acting insulin for patients with type 1 diabetes: systematic review and network meta-analysis. BMJ 2014; 349:g5459. [PMID: 25274009 PMCID: PMC4199252 DOI: 10.1136/bmj.g5459] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the safety, effectiveness, and cost effectiveness of long acting insulin for type 1 diabetes. DESIGN Systematic review and network meta-analysis. DATA SOURCES Medline, Cochrane Central Register of Controlled Trials, Embase, and grey literature were searched through January 2013. STUDY SELECTION Randomized controlled trials or non-randomized studies of long acting (glargine, detemir) and intermediate acting (neutral protamine Hagedorn (NPH), lente) insulin for adults with type 1 diabetes were included. RESULTS 39 studies (27 randomized controlled trials including 7496 patients) were included after screening of 6501 titles/abstracts and 190 full text articles. Glargine once daily, detemir once daily, and detemir once/twice daily significantly reduced hemoglobin A1c compared with NPH once daily in network meta-analysis (26 randomized controlled trials, mean difference -0.39%, 95% confidence interval -0.59% to -0.19%; -0.26%, -0.48% to -0.03%; and -0.36%, -0.65% to -0.08%; respectively). Differences in network meta-analysis were observed between long acting and intermediate acting insulin for severe hypoglycemia (16 randomized controlled trials; detemir once/twice daily versus NPH once/twice daily: odds ratio 0.62, 95% confidence interval 0.42 to 0.91) and weight gain (13 randomized controlled trials; detemir once daily versus NPH once/twice daily: mean difference 4.04 kg, 3.06 to 5.02 kg; detemir once/twice daily versus NPH once daily: -5.51 kg, -6.56 to -4.46 kg; glargine once daily versus NPH once daily: -5.14 kg, -6.07 to -4.21). Compared with NPH, detemir was less costly and more effective in 3/14 cost effectiveness analyses and glargine was less costly and more effective in 2/8 cost effectiveness analyses. The remaining cost effectiveness analyses found that detemir and glargine were more costly but more effective than NPH. Glargine was not cost effective compared with detemir in 2/2 cost effectiveness analyses. CONCLUSIONS Long acting insulin analogs are probably superior to intermediate acting insulin analogs, although the difference is small for hemoglobin A1c. Patients and their physicians should tailor their choice of insulin according to preference, cost, and accessibility. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013003610.
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada
| | - Huda M Ashoor
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada
| | - Jesmin Antony
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada
| | - Joseph Beyene
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | | | | | - Alana Harrington
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada
| | - Charlotte Wilson
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada
| | - Sophia Tsouros
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada
| | - Charlene Soobiah
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada
| | - Catherine H Yu
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8L6, Canada
| | - Jeffrey S Hoch
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada
| | - Brenda R Hemmelgarn
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, T2N 4Z6, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8L6, Canada
| | - Sumit R Majumdar
- Department of Medicine, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, M5B 1T8, Canada Department of Geriatric Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada
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Raimond V, Josselin JM, Rochaix L. HTA agencies facing model biases: the case of type 2 diabetes. PHARMACOECONOMICS 2014; 32:825-839. [PMID: 24862533 DOI: 10.1007/s40273-014-0172-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
When evaluating new drugs or treatments eligible for reimbursement, health technology assessment (HTA) agencies are repeatedly faced with cost-effectiveness analyses that evidence lack of adequate data and modeling biases. The case of type 2 diabetes illustrates this difficulty. In spite of its high disease burden, type 2 diabetes is poorly documented through existing cost-effectiveness analyses. We support this statement by an exhaustive literature review that enables us to precisely pinpoint the limitations of models used for the assessment of newly marketed (and expensive) drugs. We find that models are mostly restricted to surrogate endpoints and based on non-inferiority clinical trial data; they also show biases in the choice of comparators and inclusion criteria. Such limitations undermine the scope and applicability of HTA practice guidelines based on cost-effectiveness evidence. Nevertheless, cost-effectiveness models remain an opportunity to better inform decision makers and to reduce the uncertainty surrounding their decisions. HTA agencies are best placed to provide incentives for companies to improve the quality of the cost-effectiveness studies submitted for pricing and reimbursement decisions. One such incentive is to include stages of discussion between the company and the health authority during the evaluation process.
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Affiliation(s)
- Véronique Raimond
- Health Economics and Public Health Department, Haute Autorité de Santé, 2, avenue du Stade de France, 93218, Saint-Denis La Plaine Cedex, France,
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Cost-effectiveness of insulin glargine versus sitagliptin in insulin-naïve patients with type 2 diabetes mellitus. Clin Ther 2014; 36:1576-87. [PMID: 25151573 DOI: 10.1016/j.clinthera.2014.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/17/2014] [Accepted: 07/24/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE In the EASIE (Evaluation of Insulin Glargine Versus Sitagliptin in Insulin-Naïve Patients) trial, insulin glargine found a significant reduction in glycosylated hemoglobin compared with sitagliptin in patients with type 2 diabetes who are inadequately controlled with metformin. The objective of this study was to assess the cost-effectiveness of insulin glargine compared with sitagliptin in type 2 diabetes patients, from the perspective of the publicly funded Canadian health care system. METHODS The IMS CORE Diabetes Model, a standard Markov structure and Monte Carlo simulation model, was used. The model used a lifetime horizon to capture the long-term complications associated with type 2 diabetes. The efficacy of insulin glargine and sitagliptin in terms of glycosylated hemoglobin reduction and corresponding rates of hypoglycemia were obtained from the EASIE trial. Health utility and cost data were obtained from recently published Canadian publications. Univariate and probabilistic sensitivity analyses were conducted. FINDINGS In the lifetime base-case analysis, treatment with insulin glargine resulted in cost savings of $1434 CAD in 2012 and a gain of 0.08 quality-adjusted life years per patient. A probabilistic sensitivity analysis found the robustness of the base-case analysis, with 88% probability of insulin glargine being dominant (ie, cost savings and more quality-adjusted life years). IMPLICATIONS Insulin glargine is a clinically superior and cost-effective alternative to sitagliptin in patients with type 2 diabetes who are inadequately controlled with metformin.
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Rossetti P, Ampudia-Blasco FJ, Ascaso JF. Old and new basal insulin formulations: understanding pharmacodynamics is still relevant in clinical practice. Diabetes Obes Metab 2014; 16:695-706. [PMID: 24401118 DOI: 10.1111/dom.12256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/05/2013] [Accepted: 12/20/2013] [Indexed: 12/17/2022]
Abstract
Long-acting insulin analogues have been developed to mimic the physiology of basal insulin secretion more closely than human insulin formulations (Neutral Protamine Hagedorn, NPH). However, the clinical evidence in favour of analogues is still controversial. Although their major benefit as compared with NPH is a reduction in the hypoglycaemia risk, some cost/effectiveness analyses have not been favourable to analogues, largely because of their higher price. Nevertheless, these new formulations have conquered the insulin market. Human insulin represents currently no more than 20% of market share. Despite (in fact because of) the widespread use of insulin analogues it remains critical to analyse the pharmacodynamics (PD) of basal insulin formulations appropriately to interpret the results of clinical trials correctly. Importantly, these data may help physicians in tailoring insulin therapy to patients' individual needs and, additionally, when clinical evidence is not available, to optimize insulin treatment. For patients at low risk for/from hypoglycaemia, it might be acceptable and also cost-effective not to use long-acting insulin analogues as basal insulin replacement. Conversely, in patients with a higher degree of insulin deficiency and increased risk for hypoglycaemia, analogues are the best option due to their more physiological profile, as has been shown in PD and clinical studies. From this perspective optimizing basal insulin treatment, especially in type 2 diabetes patients who are less prone to hypoglycaemia, would be suitable making significant resources available for other relevant aspects of diabetes care.
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MESH Headings
- Chemistry, Pharmaceutical
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 2/drug therapy
- Evidence-Based Medicine
- Humans
- Hypoglycemic Agents/chemistry
- Hypoglycemic Agents/pharmacokinetics
- Hypoglycemic Agents/pharmacology
- Hypoglycemic Agents/therapeutic use
- Insulin, Long-Acting/chemistry
- Insulin, Long-Acting/pharmacokinetics
- Insulin, Long-Acting/pharmacology
- Insulin, Long-Acting/therapeutic use
- Insulin, Short-Acting/chemistry
- Insulin, Short-Acting/pharmacokinetics
- Insulin, Short-Acting/pharmacology
- Insulin, Short-Acting/therapeutic use
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Affiliation(s)
- P Rossetti
- Department of Internal Medicine, Sant Francesc de Borja Hospital, Gandia, Spain
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Sorli C, Heile MK. Identifying and meeting the challenges of insulin therapy in type 2 diabetes. J Multidiscip Healthc 2014; 7:267-82. [PMID: 25061317 PMCID: PMC4086769 DOI: 10.2147/jmdh.s64084] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic illness that requires clinical recognition and treatment of the dual pathophysiologic entities of altered glycemic control and insulin resistance to reduce the risk of long-term micro- and macrovascular complications. Although insulin is one of the most effective and widely used therapeutic options in the management of diabetes, it is used by less than one-half of patients for whom it is recommended. Clinician-, patient-, and health care system-related challenges present numerous obstacles to insulin use in T2DM. Clinicians must remain informed about new insulin products, emerging technologies, and treatment options that have the potential to improve adherence to insulin therapy while optimizing glycemic control and mitigating the risks of therapy. Patient-related challenges may be overcome by actively listening to the patient’s fears and concerns regarding insulin therapy and by educating patients about the importance, rationale, and evolving role of insulin in individualized self-treatment regimens. Enlisting the services of Certified Diabetes Educators and office personnel can help in addressing patient-related challenges. Self-management of diabetes requires improved patient awareness regarding the importance of lifestyle modifications, self-monitoring, and/or continuous glucose monitoring, improved methods of insulin delivery (eg, insulin pens), and the enhanced convenience and safety provided by insulin analogs. Health care system-related challenges may be improved through control of the rising cost of insulin therapy while making it available to patients. To increase the success rate of treatment of T2DM, the 2012 position statement from the American Diabetes Association and the European Association for the Study of Diabetes focused on individualized patient care and provided clinicians with general treatment goals, implementation strategies, and tools to evaluate the quality of care.
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Brennan VK, Colosia AD, Copley-Merriman C, Mauskopf J, Hass B, Palencia R. Incremental costs associated with myocardial infarction and stroke in patients with type 2 diabetes mellitus: an overview for economic modeling. J Med Econ 2014; 17:469-80. [PMID: 24773097 DOI: 10.3111/13696998.2014.915847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify cost estimates related to myocardial infarction (MI) or stroke in patients with type 2 diabetes mellitus (T2DM) for use in economic models. METHODS A systematic literature review was conducted. Electronic databases and conference abstracts were screened against inclusion criteria, which included studies performed in patients who had T2DM before experiencing an MI or stroke. Primary cost studies and economic models were included. Costs were converted to 2012 pounds sterling. RESULTS Fifty-four studies were identified: 13 primary cost studies and 41 economic evaluations using secondary sources for complication costs. Primary studies provided costs from 10 countries. Estimates for a fatal event ranged from £2482-£5222 for MI and from £4900-£6694 for stroke. Costs for the year a non-fatal event occurred ranged from £5071-£29,249 for MI and from £5171-£38,732 for stroke. Annual follow-up costs ranged from £945-£1616 for an MI and from £4704-£12,926 for a stroke. Economic evaluations from 12 countries were identified, and costs of complications showed similar variability to the primary studies. DISCUSSION The costs identified within primary studies varied between and within countries. Many studies used costs estimated in studies not specific to patients with T2DM. Data gaps included a detailed breakdown of resource use, which affected the ability to compare data across countries. CONCLUSIONS In the development of economic models for patients with T2DM, the use of accurate estimates of costs associated with MI and stroke is important. When country-specific costs are not available, clear justification for the choice of estimates should be provided.
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Abstract
The availability of insulin analogs has offered insulin replacement strategies that are proposed to more closely mimic normal human physiology. Specifically, there are a considerable number of reports demonstrating that prandial insulin analogs (lispro, aspart, glulisine) have pharmacokinetic and pharmacodynamic profiles closer to normal, with resulting faster onset and offset of insulin effect when compared with regular human insulin. In addition, basal insulin analogs (glargine, detemir) have been reported to offer longer duration of action, less variability, more predictability, less hypoglycemia (especially nocturnal), and a favorable effect on weight. However, an argument against use of analog insulins as compared with use of regular or NPH insulin is one that states that the effectiveness and risk of hypoglycemia are the only two valid clinical outcomes that should be used to compare the analog and human insulins. Thus, there remains a debate in some circles that analog insulins are no more effective than human insulins, yet at a much higher financial cost. To provide an in-depth understanding of both sides of the argument, we provide a discussion of this topic as part of this two-part point-counterpoint narrative. In the counterpoint narrative presented here, Dr. Davidson provides his argument and defends his opinion that outside of a few exceptions, analog insulins provide no clinical benefit compared with human insulins but cost much more. In the preceding point narrative, Dr. Grunberger provides a defense of analog insulins and their value in clinical management and suggests that when evaluating the “cost” of therapy, a much more global assessment is needed.
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Affiliation(s)
- Mayer B Davidson
- Department of Internal Medicine, Charles R. Drew University, Los Angeles, CA
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48
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Hilgenfeld R, Seipke G, Berchtold H, Owens DR. The evolution of insulin glargine and its continuing contribution to diabetes care. Drugs 2014; 74:911-27. [PMID: 24866023 PMCID: PMC4045187 DOI: 10.1007/s40265-014-0226-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The epoch-making discovery of insulin heralded a new dawn in the management of diabetes. However, the earliest, unmodified soluble insulin preparations were limited by their short duration of action, necessitating multiple daily injections. Initial attempts to protract the duration of action of insulin involved the use of various additives, including vasoconstrictor substances, which met with limited success. The subsequent elucidation of the chemical and three-dimensional structure of insulin and its chemical synthesis and biosynthesis allowed modification of the insulin molecule itself, resulting in insulin analogs that are designed to mimic normal endogenous insulin secretion during both fasting and prandial conditions. Insulin glargine was the first once-daily, long-acting insulin analog to be introduced into clinical practice more than 10 years ago and is specifically designed to provide basal insulin requirements. It has a prolonged duration of action and no distinct insulin peak, making it suitable for once-daily administration and reducing the risk of nocturnal hypoglycemia that is seen with intermediate-acting insulins. Insulin glargine can be used in combination with prandial insulin preparations and non-insulin anti-diabetic agents according to individual requirements.
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Affiliation(s)
- Rolf Hilgenfeld
- Institute of Biochemistry, Center for Structural and Cell Biology in Medicine and Center for Brain, Behavior and Metabolism, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany,
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49
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Thabit H, Hovorka R. Glucose control in non-critically ill inpatients with diabetes: towards closed-loop. Diabetes Obes Metab 2014; 16:500-9. [PMID: 24267153 DOI: 10.1111/dom.12228] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/24/2013] [Accepted: 10/28/2013] [Indexed: 01/08/2023]
Abstract
Inpatient glycaemic control remains an important issue due to the increasing number of patients with diabetes admitted to hospital. Morbidity and mortality in hospital are associated with poor glucose control, and cost of hospitalization is higher compared to non-diabetes patients. Guidelines for inpatient glycaemic control in the non-critical care setting have been published. Current recommendations include basal-bolus insulin therapy, regular glucose monitoring, as well as enhancing healthcare provider's role and knowledge. In spite of growing focus, implementation in practice is limited, mainly due to increasing workload burden on staff and fear of hypoglycaemia. Advances in healthcare technology may contribute to an improvement of inpatient diabetes care. Integration of glucose measurements with healthcare records and computerized glycaemic control protocols are currently being used in some institutions. Recent interests in continuous glucose monitoring have led to studies assessing its utilization in inpatients. Automation of glucose monitoring and insulin delivery may provide a safe and efficacious tool for hospital staff to manage inpatient hyperglycaemia, whilst reducing staff workload. This review summarizes the evidence on current approaches to managing inpatient glycaemic control; its utility and limitations. We conclude by discussing the evidence from feasibility studies to date, on the potential use of closed loop in the non-critical care setting and its implication for future studies.
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Affiliation(s)
- H Thabit
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
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50
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Suh DC, Aagren M. Cost–effectiveness of insulin detemir: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2014; 11:641-55. [DOI: 10.1586/erp.11.73] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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