Pharmacoeconomic evaluation of insulin aspart and glargine in type 1 and 2 diabetes mellitus in Iran.

IF 1.8 Q4 ENDOCRINOLOGY & METABOLISM Journal of Diabetes and Metabolic Disorders Pub Date : 2023-04-08 eCollection Date: 2023-06-01 DOI:10.1007/s40200-023-01209-1
Marzieh Nosrati, Soroush Ahmadi Fariman, Parisa Saiyarsarai, Shekoufeh Nikfar
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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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天冬氨酸胰岛素和甘精胰岛素治疗伊朗1型和2型糖尿病的药物经济学评价。
目的:胰岛素类似物,包括短效天冬氨酸胰岛素(IAsp)和长效甘精胰岛素(IGla),尽管具有改善的药代动力学和药效学特性以及患者方便性,但其成本较高,限制了其广泛使用。本研究旨在从伊朗医疗系统的角度评估IAsp与常规胰岛素(RI)以及IGla与NPH胰岛素在1型和2型糖尿病中的成本效益。方法:从纳入的系统综述和荟萃分析研究中获得包括HbA1c水平、低血糖、体重增加和健康相关生活质量在内的临床数据。在每年的时间范围内使用不同的药物经济学评价方法。糖尿病相关并发症的效用递减从文献中提取。直接医疗费用按2022年价格计算。还进行了单向灵敏度分析。结果:在1型糖尿病中,与RI相比,IAsp在降低HbA1c方面具有更多的成本和效果。估计每名患者每年的HbA1c可额外降低1%,增量成本为83美元。同样,与NPH相比,IGla的增量成本估计为16美元。在2型糖尿病中,IAsp和RI具有同等的疗效和安全性。对于IGla与NPH,增量成本效益比计算为每质量调整生命年1975美元。通过灵敏度分析证实了结果的稳健性。结论:与人胰岛素RI和NPH相比,胰岛素类似物IAsp和IGla治疗1型糖尿病具有成本效益。对于2型糖尿病,与RI相比,IAsp不具有成本效益。然而,对于IGla与NPH,增量成本效益比似乎在可接受的阈值内。
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来源期刊
Journal of Diabetes and Metabolic Disorders
Journal of Diabetes and Metabolic Disorders Medicine-Internal Medicine
CiteScore
4.80
自引率
3.60%
发文量
210
期刊介绍: Journal of Diabetes & Metabolic Disorders is a peer reviewed journal which publishes original clinical and translational articles and reviews in the field of endocrinology and provides a forum of debate of the highest quality on these issues. Topics of interest include, but are not limited to, diabetes, lipid disorders, metabolic disorders, osteoporosis, interdisciplinary practices in endocrinology, cardiovascular and metabolic risk, aging research, obesity, traditional medicine, pychosomatic research, behavioral medicine, ethics and evidence-based practices.As of Jan 2018 the journal is published by Springer as a hybrid journal with no article processing charges. All articles published before 2018 are available free of charge on springerlink.Unofficial 2017 2-year Impact Factor: 1.816.
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