Unchalee Permsuwan1, Kednapa Thavorn2,3,4, Piyameth Dilokthornsakul5, Surasak Saokaew6,7, Nathorn Chaiyakunapruk5,7,8,9. 1. a Faculty of Pharmacy , Chiang Mai University , Chiang Mai , Thailand. 2. b Ottawa Hospital Research Institute, The Ottawa Hospital , Ottawa , Ontario , Canada. 3. c School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine , University of Ottawa , Ottawa , Ontario , Canada. 4. d Institute of Clinical and Evaluative Sciences (ICES@UOttawa) , Ottawa , Ontario , Canada. 5. e Center of Pharmaceutical Outcome Research (CPOR), Faculty of Pharmaceutical Sciences , Naresuan University , Phitsanulok , Thailand. 6. f Center of Health Outcomes Research and Therapeutic Safety (COHORTS), School of Pharmaceutical Sciences , University of Phayao , Phayao , Thailand. 7. g School of Pharmacy , Monash University Malaysia , Malaysia. 8. h School of Population Health , University of Queensland , Brisbane , Australia. 9. i Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster , Global Asia in the 21st Century (GA21) Platform, Monash University , Malaysia, Bandar Sunway , Selangor , Malaysia.
Abstract
AIMS: An economic evidence is a vital tool that can inform the decision to use costly insulin analogs. This study aimed to evaluate long-term cost-effectiveness of insulin detemir (IDet) compared with insulin glargine (IGlar) in type 2 diabetes (T2DM) from the Thai payer's perspective. METHODS: Long-term costs and outcomes were projected using a validated IMS CORE Diabetes Model, version 8.5. Cohort characteristics, baseline risk factors, and costs of diabetes complications were derived from Thai data sources. Relative risk was derived from a systematic review and meta-analysis study. Costs and outcomes were discounted at 3% per annum. Incremental cost-effectiveness ratio (ICER) was presented in 2015 US Dollars (USD). A series of one-way and probabilistic sensitivity analyses were performed. RESULTS: IDet yielded slightly greater quality-adjusted life years (QALYs) (8.921 vs 8.908), but incurred higher costs than IGlar (90,417.63 USD vs 66,674.03 USD), resulting in an ICER of ∼1.7 million USD per QALY. The findings were very sensitive to the cost of IDet. With a 34% reduction in the IDet cost, treatment with IDet would become cost-effective according to the Thai threshold of 4,434.59 USD per QALY. CONCLUSIONS: Treatment with IDet in patients with T2DM who had uncontrolled blood glucose with oral anti-diabetic agents was not a cost-effective strategy compared with IGlar treatment in the Thai context. These findings could be generalized to other countries with a similar socioeconomics level and healthcare systems.
AIMS: An economic evidence is a vital tool that can inform the decision to use costly insulin analogs. This study aimed to evaluate long-term cost-effectiveness of insulin detemir (IDet) compared with insulinglargine (IGlar) in type 2 diabetes (T2DM) from the Thai payer's perspective. METHODS: Long-term costs and outcomes were projected using a validated IMS CORE Diabetes Model, version 8.5. Cohort characteristics, baseline risk factors, and costs of diabetes complications were derived from Thai data sources. Relative risk was derived from a systematic review and meta-analysis study. Costs and outcomes were discounted at 3% per annum. Incremental cost-effectiveness ratio (ICER) was presented in 2015 US Dollars (USD). A series of one-way and probabilistic sensitivity analyses were performed. RESULTS: IDet yielded slightly greater quality-adjusted life years (QALYs) (8.921 vs 8.908), but incurred higher costs than IGlar (90,417.63 USD vs 66,674.03 USD), resulting in an ICER of ∼1.7 million USD per QALY. The findings were very sensitive to the cost of IDet. With a 34% reduction in the IDet cost, treatment with IDet would become cost-effective according to the Thai threshold of 4,434.59 USD per QALY. CONCLUSIONS: Treatment with IDet in patients with T2DM who had uncontrolled blood glucose with oral anti-diabetic agents was not a cost-effective strategy compared with IGlar treatment in the Thai context. These findings could be generalized to other countries with a similar socioeconomics level and healthcare systems.
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Authors: Thales B C Silva; Paulo H R F Almeida; Vania E Araújo; Francisco de Assis Acurcio; Augusto A Guerra Júnior; Brian Godman; Juliana Alvares Journal: Ther Adv Endocrinol Metab Date: 2018-06-22 Impact factor: 3.565