Basal Supported Oral Therapy with Insulin Glargine Results in Longer Persistence and Lower Costs Compared with Insulin Detemir in Type 2 Diabetics in Germany

Abstract Objective To investigate the persistence of basal supported oral therapy (BOT) with either insulin glargine (GLA) or insulin detemir (DET) in type 2 diabetics and to assess long-term costs associated with the initiation of respective treatment regimens. Study Design A cost comparison was conducted from the perspective of the German statutory health insurance, applying a Markov model. Two base case scenarios were conducted. Transition probabilities from BOT to intensified conventional therapy (ICT) for scenario 1 were obtained from 5-year persistence data on BOT of the IMS Disease Analyzer (IMS Health Inc. Frankfurt am Main, Germany). Transition probabilities applied for scenario 2 were based on a regression equation of extrapolated persistence data for 10 years. A BOT initiation using GLA and DET at a ratio of 1:1 was assumed. Treatment costs of BOT and ICT with GLA and DET were derived from published sources. Estimation of type 2 diabetics starting a BOT was based on epidemiologic data from the literature. The model was operated over 5 and 10 years for scenarios 1 and 2, respectively. Costs were discounted by 5% per annum in the base case analyses, and varied to 0% and 10%. Multiple one-way sensitivity analyses were conducted varying input cost data. Results Based on the persistence data, the cumulative 5-year costs for a cohort of 44,366 type 2 diabetics were 134 million € (GLA) versus 179 million € (DET), resulting in savings of 45 million € in favor of insulin glargine. Total 10-year treatment costs based on the regression equation were 272 million € (GLA) versus 338 million € (DET), resulting in savings of 66 million € in favor of insulin glargine. In sensitivity analyses, cost savings over 10 years for GLA versus DET ranged from € 53 to € 97 million. Conclusions Starting an insulin therapy with GLA- rather than DET-based BOT results in a later initiation of ICT in type 2 diabetics. Because treatment costs of an ICT are roughly twice that of a BOT, the longer persistence using GLA shows potential cost savings of € 67 million for the German statutory health insurance within 10 years compared with DET.