老年糖尿病髋关节置换术后患者出院时的药物指导

目的：探讨老年糖尿病患者髋关节置换术后出院时药物指导的意义。方法患者出院时根据血糖测定指标和肝肾功能、血压等情况选择药物,指导患者严格执行医嘱,按时用药,定时检测血糖指标,告知应用降糖药物的注意事项和不良反应,预防低血糖的方法及发生低血糖时的紧急处理措施。结果118例患者术后6～12个月获随访,降糖药物应用的依从性为96.6%,血糖测定的主要指标控制情况为理想控制为32.2%,较好控制为42.4%,一般控制为23.7%,未能控制为1.7%。结论老年糖尿病髋关节置换术后患者出院时药物指导应依据安全、有效、经济的原则,根据患者具体病情个体化给药,可提高患者的依从性,最大发挥降糖药物治疗作用,避免和降低不良反应,使患者血糖达到理想指标,促进患者的康复。     

口服降糖药物联合甘精胰岛素治疗2型糖尿病的疗效分析

目的评价口服降糖药物联合甘精胰岛素治疗2型糖尿病的临床疗效。方法对我院67例单用口服降糖药物效果欠佳的2型糖尿病患者,于睡前加用甘精胰岛素治疗,比较治疗前后空腹血糖(FPG)、餐后2 h血糖(2 h PG)、空腹C肽(FCP)、餐后2 h C肽(2 h CP)、糖化血红蛋白(HbA1c)及体质量指数(BMI)等指标与低血糖发生率。结果经治疗后,患者的FPG、2 h PG和HbA1c均较治疗前明显降低,而FCP、2 h CP均较治疗前有所升高,差异均有统计学意义(P<0.05)。结论口服降糖药物联合甘精胰岛素治疗2型糖尿病疗效明显且安全性较高,患者血糖能够得到较好的控制。     

门诊抗高血压药物应用分析

目的介绍我院门诊抗高血压药物的使用情况,为临床合理用药提供参考。方法选取我院2013年的处方,从中筛选出含有抗高血压药物的处方,采用世界卫生组织（WHO）推荐的限定日剂量（DDD）等方法进行统计、分析。结果 28 208张门诊处方中使用抗高血压药物的处方有5 005张,占总处方数的17.7%。抗高血压药物在门诊使用较多,钙通道拮抗药（CCB）使用率最高,处方中抗高血压药物多为联合用药。结论我院门诊抗高血压药物使用基本合理,大多为联合用药,但仍需进一步提高。     

门诊处方调查分析

目的研究分析门诊处方的调查情况。方法选择我院门诊于2012年第二季度的5221张处方进行调查分析。结果在5221张处方中,处方超过五种药品率是27.88%,诊断书写不清率是21.05%,诊断书不规范率是9.36%,诊断与用药不符率是3.70%,处方填写缺项率是10.33%,未使用药品通用名称率是8.19%,用法用量书写不规范率是7.02%,超过规范用量率是7.41%,处方修改未签字率是2.92%,规格剂量书写错误率是2.14%。结论通过不断调查统计,总结问题,不断制订整改方案,不断完善药物处方的合理性。医院门诊医师应具备高度的责任感,认真对待每一张医药处方,保证每例患者使用药物的安全性及有效性。     

胰岛素强化治疗对早期2型糖尿病肾病患者的影响

目的探讨在早期2型糖尿病肾病的治疗中应用胰岛素强化治疗的临床效果。方法选取2019年1月至2021年1月盘锦市人民医院收治的86例早期2型糖尿病肾病患者作为研究对象,按随机数字表法分为对照组与观察组,各43例。单纯接受口服降糖药物治疗的为对照组,在口服降糖药物治疗基础上联合胰岛素强化治疗的为观察组,比较两组的治疗效果。结果观察组治疗有效率为95.35%,高于对照组的76.74%,差异有统计学意义(P<0.05);治疗后,观察组空腹血糖(FBG)、餐后2 h血糖(2hPBG)、糖化血红蛋白(HbAlc)低于对照组,差异有统计学意义(P<0.05);治疗后,观察组尿微量白蛋白排泄率(UAER)、β_(2)-微球蛋白(β;-MG)、胆固醇(TC)、三酰甘油(TG)低于对照组,差异有统计学意义(P<0.05)。结论早期2型糖尿病肾病患者接受胰岛素强化治疗在稳定血糖、提高治疗效果、改善蛋白尿等方面效果显著,能有效延缓糖尿病肾病进程,与口服降糖药物相比优势明显。     

格华止与甘精胰岛素联合治疗肥胖型2型糖尿病的临床观察

目的观察格华止与甘精胰岛素联合治疗肥胖型2型糖尿病对空腹血糖、餐后2h血糖、糖化血红蛋白、体重指数的疗效。方法采用动态血糖检测对68例肥胖型2型糖尿病患者给予甘精胰岛素睡前皮下注射,同时三餐前据血糖口服格华止降糖,2~3个月后复查血糖、糖化血红蛋白、体重指数,比较治疗前后血糖、糖化血红蛋白、体重指数的变化,同时观察胰岛素用量的变化。结果格华止降低餐后高血糖明显,同时减轻体重,体重指数下降,抵消胰岛素增重的副作用,增强胰岛素的敏感性,胰岛素用量下降。甘精胰岛素弥补了患者基础胰岛素分泌不足的缺点,同时有效避免夜间低血糖的发生。结论格华止与甘精胰岛素联合治疗肥胖型2型糖尿病,患者空腹血糖、餐后2h血糖、糖化血红蛋白、体重指数均明显下降(P>0.05),胰岛素用量减少,夜间低血糖发生降低。     

中医辨证分型治疗2型糖尿病的临床疗效

目的研究2型糖尿病患者经中医辨证分型治疗的疗效。方法选取共乐社区卫生服务中心在2013年2月至2015年1月间收治的106例2型糖尿病患者的临床资料,将患者随机分为两组,各有53例。对照组给予常规降糖药物治疗,观察组在对照组基础上采用中医辨证治疗。比较两组患者的治疗效果、餐后2 h血糖、空腹血糖指标。结果 1观察组治疗有效率为96.23%,对照组治疗有效率为81.13%,比较有统计学意义(P<0.05)。2观察组治疗后的血糖指标改善效果优于对照组,比较有统计学意义(P<0.05)。结论 2型糖尿病患者经中医辨证分型治疗,可以提高临床治疗有效率,改善患者的餐后2 h血糖、空腹血糖指标,值得临床推广应用。     

儿科住院患者抗菌药物应用分析

目的分析我院儿科住院患者抗菌药物应用情况。方法回顾性分析我院2011～2013年860例儿科住院患者抗菌药物的使用情况,对其使用率、联用率和标本送检情况以及所用抗菌药物的品种进行分析。结果 860例儿科住院患者抗菌药物的使用例数为784例,使用率为91.2%,抗菌药物的联用例数为186例,联用率为21.6%,其中双联例数131例,双联率15.2%,累计使用38个品种,以头孢菌素类和青霉素类为主;784例抗菌药物使用者中有104例标本送检,标本送检率为13.3%,104例中有22例检出阳性,阳性率为21.2%。结论我院儿科住院患者抗菌药物的使用存在诸多不合理现象,需加强管理。     

PDCA在出院患者三级电话回访绩效管理中的应用效果分析

为了探讨PDCA循环法在医院出院患者三级电话回访中的应用效果,将2017年下半年200名a临床科室以传统电话回访设为对照组进行分析,a临床科室2018年上半年200名患者以PDCA循环法进行三级电话回访管理方式设为实验组,将两组回访成功率和满意度进行对比。结果表明,PDCA组成功率和满意度明显高于对照组,差异有统计学意义(P<0.05)。从而得出结论:采用PDCA循环法进行医院出院患者三级电话回访管理,可有效地提高管理绩效和患者满意度。     

中药联合使用中存在的不合理性

目的针对目前中药联合使用中普遍存在的不合理性进行讨论,希望引起医师和药师的重视,提高中药联合使用的合理性。方法通过抽取我院2010年1月～2012年1月100例门诊中药处方,筛选中药联合使用不合理处方,分析其原因。结果 100例门诊中药处方中,中药联合使用不合理处方有17例(17%),不合理性多见于医生不懂药物配伍禁忌,存在"十八反"、"十九畏"处方以及药物剂量的不合理性。结论通过对中药联合使用中存在不合理性的分析与思考,有针对性的改革中药处方的配伍禁忌,以便医生更加准确的应用中药制剂,给患者提供更加安全、可靠的治疗服务。     

Evaluation of the cost-utility of insulin degludec vs insulin glargine in Sweden

Abstract

Objective:

To evaluate the annual cost-utility of insulin degludec compared with glargine in patients with: type 1 diabetes (T1D), type 2 diabetes receiving basal-only therapy (T2D-BOT), and type 2 diabetes receiving basal-bolus therapy (T2B-BB) in Sweden.

Methods:

A cost-utility model was programmed in Microsoft Excel to evaluate clinical and economic outcomes. The clinical trials were designed as treat-to-target, with insulin doses adjusted in order to achieve similar glycemic control between treatments, thus long-term modeling is not meaningful. Basal and bolus insulin doses, incidence of hypoglycemic events, frequency of self-monitoring of blood glucose, and possibility for flexibility in timing of dose administration were specified for each insulin in three diabetes populations, based on data collected in Swedish patients with diabetes and a meta-analysis of clinical trials with degludec. Using these characteristics, the model estimated costs from a societal perspective and quality-adjusted life years (QALYs) in the two scenarios.

Results:

Use of degludec was associated with a QALY gain compared with glargine in T1D (0.31 vs 0.26?QALYs), T2D-BOT (0.76 vs 0.69?QALYs), and T2D-BB (0.56 vs 0.47?QALYs), driven by reduced incidence of hypoglycemia and possibility for flexibility around timing of dose administration. Therapy regimens containing degludec were associated with increased costs compared to glargine-based regimens, driven by the increased pharmacy cost of basal insulin, but partially offset by other cost savings. Based on estimates of cost and clinical outcomes, degludec was associated with incremental cost-effectiveness ratios of SEK 19,766 per QALY gained, SEK 10,082 per QALY gained, and SEK 36,074 per QALY gained in T1D, T2-BOT, and T2-BB, respectively.

Limitations:

The hypoglycemic event rates in the base case analysis were derived from a questionnaire-based study that relied on patient interpretation and recall of hypoglycemic symptoms. The relative rates of hypoglycemia with degludec compared to glargine were derived from a meta-analysis of phase III trials, which may not reflect the relative rates observed in real-world clinical practice. Both of these key limitations were explored in one-way sensitivity analyses.

Conclusions:

Based on reduced incidence of hypoglycemia and possibility for flexibility around timing of dose administration, use of degludec is likely to be cost-effective compared to glargine from a societal perspective in T1D, T2-BOT, and T2-BB in Sweden over a 1-year time horizon.     

The psychosocial and financial impact of non-severe hypoglycemic events on people with diabetes: two international surveys

Objectives:

To understand the impact of nocturnal and daytime non-severe hypoglycemic events on healthcare systems, work productivity and quality of life in people with type 1 or type 2 diabetes.

Methods:

People with diabetes who experienced a non-severe hypoglycemic event in the 4 weeks prior to the survey were eligible to participate in a nocturnal and/or daytime hypoglycemia survey. Surveys were conducted in Argentina, Australia, Brazil, Israel, Mexico and South Africa.

Results:

In total, 300 respondents were included in nocturnal/daytime hypoglycemia surveys (50/participating country/survey). All respondents with type 1 diabetes and 68%/62% (nocturnal/daytime) with type 2 diabetes were on insulin treatment. After an event, 25%/30% (nocturnal/daytime) of respondents decreased their insulin dose and 39%/36% (nocturnal/daytime) contacted a healthcare professional. In the week after an event, respondents performed an average of 5.6/6.4 (nocturnal/daytime) additional blood glucose tests. Almost half of the respondents (44%) reported that the event had a high impact on the quality of their sleep. Among nocturnal survey respondents working for pay, 29% went to work late, 16% left work early and 12% reported missing one or more full work days due to the surveyed event. In addition, 50%/39% (nocturnal/daytime) indicated that the event had a high impact on their fear of future hypoglycemia.

Conclusions:

The findings suggest that nocturnal and daytime non-severe hypoglycemic events have a large financial and psychosocial impact. Diabetes management that minimizes hypoglycemia while maintaining good glycemic control may positively impact upon the psychological wellbeing of people with diabetes, as well as reducing healthcare costs and increasing work productivity.     

Effects of patient-reported non-severe hypoglycemia on healthcare resource use,work-time loss,and wellbeing in insulin-treated patients with diabetes in seven European countries

Abstract

Purpose:

Hypoglycemia is a frequent side effect induced by insulin treatment of type 1 (T1DM) and type 2 diabetes (T2DM). Limited data exist on the associated healthcare resource use and patient impact of hypoglycemia, particularly at a country-specific level. This study investigated the effects of self-reported non-severe hypoglycemic events (NSHE) on use of healthcare resources and patient wellbeing.

Methods:

Patients with T1DM or insulin-treated T2DM diabetes from seven European countries were invited to complete four weekly questionnaires. Data were collected on patient demographics, NSHE occurrence in the last 7 days, hypoglycemia-related resource use, and patient impact. NSHE were defined as events with hypoglycemia symptoms, with or without blood glucose measurement, or low blood glucose measurement without symptoms, which the patient could manage without third-party assistance.

Results:

Three thousand, nine hundred and fifty-nine respondents completed at least one wave of the survey, with 57% completing all four questionnaires; 3827 respondents were used for data analyses. Overall, 2.3% and 8.9% of NSHE in patients with T1DM and T2DM, respectively, resulted in healthcare professional contact. Across countries, there was a mean increase in blood glucose test use of 3.0 tests in the week following a NSHE. Among respondents who were employed (48%), loss of work-time after the last hypoglycemic event was reported for 9.7% of NSHE. Overall, 10.2% (daytime) and 8.0% (nocturnal) NSHE led to work-time loss, with a mean loss of 84.3 (daytime) and 169.6 (nocturnal) minutes among patients reporting work-time loss. Additionally, patients reported feeling tired, irritable, and having negative feelings following hypoglycemia.

Limitations:

Direct comparisons between studies must be interpreted with caution because of different definitions of hypoglycemia severity, duration of the studies, and methods of data collection.

Conclusions:

NSHE were associated with use of extra healthcare resources and work-time loss in all countries studied, suggesting that NSHE have considerable impact on patients/society.     

Real-world rates,predictors, and associated costs of hypoglycemia among patients with type 2 diabetes mellitus treated with insulin glargine: results of a pooled analysis of six retrospective observational studies

Abstract

Objective:

To evaluate the real-world rates of hypoglycemia and related costs among patients with type 2 diabetes mellitus (T2DM) who initiated insulin glargine with either a disposable pen or vial-and-syringe.

Methods:

Pooled data were evaluated from six previously published, retrospective, observational studies using US health plan insurance claims databases to investigate adults with T2DM who initiated insulin glargine. The current study evaluated baseline characteristics, hypoglycemic events, and costs during the 6 months prior to and 12 months following insulin glargine initiation. Comparisons were made between patients initiating treatment with a disposable pen (GLA-P) and vial-and-syringe (GLA-V). Multivariate analyses using baseline characteristics as covariates determined predictors of hypoglycemia after initiating insulin glargine.

Results:

This study included 23,098 patients (GLA-P: 14,911; GLA-V: 8187). Overall annual prevalence of hypoglycemia was low (6.3% overall, 2.2% related to hospital admission or emergency department visit). Prevalence was significantly lower with GLA-P (5.5% vs 7.7%; p?<?0.0001). Furthermore, average glycated hemoglobin HbA1c reduction was higher with GLA-P (?1.22% vs ?0.86%; p?=?0.0012). The average annual hypoglycemia-related cost associated with initiating insulin glargine was $293, with GLA-P being 46% lower than GLA-V ($225 vs $417; p?=?0.001). Patients who had already developed microvascular complications at the time of initiating insulin therapy were at higher risk for developing hypoglycemia.

Limitations:

This study is limited by the use of retrospective data and ICD-9-CM codes, which are subject to coding error. In addition, this pooled analysis used unmatched cohorts, with multivariate regression analyses employed to adjust for between-group differences. Finally, results describe a managed care sample and cannot be generalized to all patients with T2DM.

Conclusions:

Patients with T2DM initiating insulin glargine treatment showed low rates of hypoglycemia, especially when using a disposable pen device. Hypoglycemia-related costs were low, contributing a very small proportion to overall diabetes-related healthcare costs.     

The cost-effectiveness and budget impact of stepwise addition of bolus insulin in the treatment of type 2 diabetes: evaluation of the FullSTEP trial

Background and aims:

Intensification of basal insulin-only therapy in type 2 diabetes is often achieved through addition of bolus insulin 3-times daily. The FullSTEP trial demonstrated that stepwise addition (SWA) of bolus insulin aspart was non-inferior to full basal-bolus (FBB) therapy and reduced the rate of hypoglycemia. Here the cost-effectiveness and budget impact of SWA is evaluated.

Methods:

Cost-effectiveness and budget impact models were developed to assess the cost and quality-of-life (QoL) implications of intensification using SWA compared with FBB in the US setting. At assessment, SWA patients added one bolus dose to their current regimen if the HbA1c target was not met. SWA patients reaching three bolus doses used FBB event rates. Outcomes were evaluated at trial end and projected annually up to 5 years. Models captured hypoglycemic events, the proportion meeting HbA1c target, and self-measured blood glucose. Event rates and QoL utilities were taken from trial data and published literature. Costs were evaluated from a healthcare-payer perspective, reported in 2013 USD, and discounted (like clinical outcomes) at 3.5% annually. This analysis applies to patients with HbA1c 7.0–9.0% and body mass index <40?kg/m².

Results:

SWA was associated with improved QoL and reduced costs compared with FBB. Improvement in QoL and cost reduction were driven by lower rates of hypoglycemia. Sensitivity analyses showed that outcomes were most influenced by the cost of bolus insulin and QoL impact of symptomatic hypoglycemia. Budget impact analysis estimated that, by moving from FBB to SWA, a health plan with 77,000 patients with type 2 diabetes, of whom 7.8% annually intensified to basal-bolus therapy, would save USD 1304 per intensifying patient over the trial period.

Conclusions:

SWA of bolus insulin should be considered a beneficial and cost-saving alternative to FBB therapy for the intensification of treatment in type 2 diabetes.     

Cost-effectiveness of insulin degludec compared with insulin glargine in a basal-bolus regimen in patients with type 1 diabetes mellitus in the UK

Abstract

Objective:

The aim of this study was to evaluate the cost-effectiveness of insulin degludec (IDeg) vs insulin glargine (IGlar) as part of a basal-bolus treatment regimen in adults with T1DM, using a short-term economic model.

Methods:

Data from two phase III clinical studies were used to populate a simple and transparent short-term model. The costs and effects of treatment with IDeg vs IGlar were calculated over a 12-month period. The analysis was conducted from the perspective of the UK National Health Service. Sensitivity analyses were conducted to assess the degree of uncertainty surrounding the results. The main outcome measure, the incremental cost-effectiveness ratio (ICER), was the cost per quality-adjusted life-year (QALY).

Results:

IDeg is a cost-effective treatment option vs IGlar in patients with T1DM on a basal-bolus regimen. The base case ICER was estimated at £16,895/QALY, which is below commonly accepted thresholds for cost-effectiveness in the UK. Sensitivity analyses demonstrated that the ICER was stable to variations in the majority of input parameters. The parameters that exerted the most influence on the ICER were hypoglycemia event rates, daily insulin dose, and disutility associated with non-severe nocturnal hypoglycemic events. However, even under extreme assumptions in the majority of analyses the ICERs remained below the commonly accepted threshold of £20,000–£30,000 per QALY gained.

Conclusions:

This short-term modeling approach accommodates the treat-to-target trial design required by regulatory bodies, and focuses on the impact of important aspects of insulin therapy such as hypoglycemia and dosing. For patients with T1DM who are treated with a basal-bolus insulin regimen, IDeg is a cost-effective treatment option compared with IGlar. IDeg may be particularly cost-effective for sub-groups of patients, such as those suffering from recurrent nocturnal hypoglycemia and those with impaired awareness of hypoglycemia.     

Hypoglycemia: An overview of fear of hypoglycemia,quality-of-life,and impact on costs

Abstract

Background:

The clinical goal in the treatment of diabetes is to achieve good glycemic control. Tight glycemic control achieved with intensive glucose lowering treatment reduces the risk of long-term micro- and macro-vascular complications of diabetes, resulting in an improvement in quality-of-life for the patient and decreased healthcare costs. The positive impact of good glycemic control is, however, counterbalanced by the negative impact of an increased incidence of hypoglycemia.

Methods:

A search of PubMed was conducted to identify published literature on the impact of hypoglycemia, both on patient quality-of-life and associated costs to the healthcare system and society.

Results:

In people with type 1 or type 2 diabetes, hypoglycemia is associated with a reduction in quality-of-life, increased fear and anxiety, reduced productivity, and increased healthcare costs. Fear of hypoglycemia may promote compensatory behaviors in order to avoid hypoglycemia, such as decreased insulin doses, resulting in poor glycemic control and an increased risk of serious health consequences. Every non-severe event may be associated with a utility loss in the range of 0.0033–0.0052 over 1 year, further contributing to the negative impact.

Limitations:

This review is intended to provide an overview of hypoglycemia in diabetes and its impact on patients and society, and consequently it is not a comprehensive evaluation of all studies reporting hypoglycemic episodes.

Conclusion:

To provide the best possible care for patients and a cost-effective treatment strategy for healthcare decision-makers, a treatment that provides good glycemic control with a limited risk of hypoglycemia would be a welcome addition to diabetes management options.     

Economic impact of hypoglycemia among insulin-treated patients with diabetes

Objective: The objective of this study was to assess the cost of hypoglycemic events among insulin-treated patients with diabetes and the potential cost savings to a hypothetical US health plan and employer of reducing hypoglycemic events with a device intervention.

Methods: A cost-calculator model was developed to estimate the direct costs of hypoglycemic events, accounting for diabetes type, age, and event severity. Model inputs were derived from published incidence rates of hypoglycemic events and direct medical costs. Assumed intervention efficacy was based on published studies of an emerging technology which yielded 72.2% (LGS Trial; ACTRN12610000024044) and 31.8% (ASPIRE Trial; NCT01497938) reductions in severe and non-severe hypoglycemic events, respectively. Model outcomes—including the number of severe (requiring medical assistance) and non-severe events, and direct/indirect medical costs (excluding intervention costs)—were evaluated over a 1-year period for a hypothetical health plan and employer perspectives.

Results: In a health plan with 10 million enrollees, patients without the intervention would have experienced 0.09 and 14.60 severe and non-severe hypoglycemic events per patient per year (PPPY), respectively (vs 0.02 severe and 9.96 non-severe events with the intervention). This translated into total direct medical cost savings of $45 million ($177 PPPY) for the health plan. For an employer with 100,000 employees, the intervention would have yielded additional savings of $492 PPPY in indirect costs.

Conclusion: Insulin-treated patients experience hypoglycemic events, which are associated with substantial direct and indirect medical costs. The cost savings of reducing hypoglycemic events need to be weighed against the costs of using diabetes device interventions.     

The economic impact of insulin-related hypoglycemia in Denmark: an analysis using the Local Impact of Hypoglycemia Tool

Aims: To estimate the direct cost of hypoglycemia in insulin-treated adults with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in Denmark.

Materials and methods: The Local Impact of Hypoglycemia Tool (LIHT) was used to estimate the costs associated with insulin-related hypoglycemia. Average utilization of healthcare resources, including the costs of pre-hospitalization, hospital admission, healthcare professional contact and follow-up, glucose/glucagon, and extra SMBG tests to monitor blood glucose following an episode, was used to calculate an average cost per severe and per non-severe hypoglycemic episode. The cost per episode was then applied to the rates of severe and non-severe hypoglycemia in people with T1DM and T2DM in Denmark.

Results: The direct cost of insulin-related hypoglycemia in Denmark is DKK 96.2 million per year, which equates to EUR 12.9 million. For people with T1DM prone to severe hypoglycemia (defined as having ≥2 severe episodes in the past year), the cost per person per year increases by DKK 4,155 compared with the T1DM population average, and for people with T2DM prone to non-severe hypoglycemia (defined as having ≥1 non-severe episode in the last 4 weeks), the cost increases by DKK 647 per person per year compared with the T2DM population average.

Conclusions: The LIHT highlights the substantial economic burden of insulin-related hypoglycemia in Denmark, and provides a means to estimate the savings that could be made by lowering hypoglycemia rates. For example, the costs associated with using a new insulin or introducing a patient education program could be offset with the cost saving from reducing hypoglycemia.     

Cost-effectiveness of switching to insulin degludec from other basal insulins in real-world clinical practice in Italy

Abstract

Aims: The costs associated with insulin therapy and diabetes-related complications represent a significant and growing economic burden for healthcare systems. The aim of this study was to evaluate the cost-effectiveness of switching to insulin degludec (degludec) vs continuing previous basal insulin, in Italian patients with type 1 (T1D) or type 2 (T2D) diabetes, using a long-term economic model.

Materials and methods: Data were retrieved from a real-world population of patients from clinical practice in Italy. Clinical parameters included in the base-case model were change from baseline in HbA_1c, rates of hypoglycemia, and basal and bolus insulin dose, at 6?months following switch to degludec. Costs of treatments were taken from official Italian pharmaceutical list prices and costs of hypoglycemia were based on the literature. The data were used to populate a long-term (lifetime) IQVIA CORE Diabetes Model to evaluate the incremental cost-effectiveness ratio (ICER) – cost per quality-adjusted life-year (QALY). The robustness of these results was tested with extensive sensitivity analyses by varying the time horizons and abolishing each of the treatment differences and previous basal insulins.

Results: The total incremental cost for degludec vs previous basal insulin was €–6,310 and €–2,682 for patients with T1D and T2D, respectively; the switch to degludec resulted in a QALY gain of 0.781 and 0.628. The long-term ICER for degludec vs continuing the previous basal insulin regimen showed that degludec was dominant for both T1D and T2D, meaning that patient health was improved in terms of QALYs with lower healthcare costs. Sensitivity analyses showed that degludec remained dominant in most scenarios including after elimination of any benefit in non-severe hypoglycemia and insulin dose, in both T1D and T2D.

Conclusions: Under routine care, switching to degludec is dominant, compared with continuing previous basal insulin, in Italian patients with T1D or T2D.