OBJECTIVES

People with type 2 diabetes typically require insulin treatment following failure on oral anti-diabetic agents. Although Insulin glargine (IGlar) has been available and used in Iran for a decade, it has not been evaluated in terms of cost-effectiveness. This study was aimed to evaluate the long-term cost effectiveness of IGlar versus neutral protamine Hagedorn (NPH) insulin in type 2 diabetes from the perspective of Iran Healthcare System.

METHODS

A validated computer simulation model (the UKPDS Outcome Model) was used to estimate the long-term projection of costs and clinical outcomes of a cohort of 1000 subjects over a life time horizon. The model was populated with published characteristics of Iranian patients with type 2 diabetes. Baseline risk factors were obtained from Iranian cohort studies, while relative risk reduction was derived from a meta-analysis study conducted by authors. Only direct costs were taken into account. Costs of diabetes management and complications were obtained from hospital databases. Both costs and outcomes were discounted at 5 % per annum and presented in US dollars value (US$1 = IRR 42,000). Incremental cost-effectiveness ratio (ICER) was calculated. One-way and probabilistic sensitivity analyses were also performed.

RESULTS

IGlar is associated with a slight gain in quality-adjusted life years (0.225 QALYs) and an incremental cost of IRR 39,815,103 (US$947.9) compared with NPH insulin. The ICER was IR177,284,167/QALY (US$4221/QALY) and was sensitive to IGlar cost. At the acceptable willingness to pay of 1 GDP/capita (US$4430), the probability of being cost effective was 51% for IGlar versus NPH. Results from scenario analyses were consistent with that from base case analysis.

CONCLUSIONS

Insulin glargine resulted in significant health benefits and represents excellent value for money for the treatment of type 2 diabetes patients who had uncontrolled blood glucose with oral anti-diabetic agents at the acceptable threshold in Iran.