Качественная клиническая практика (May 2022)
The clinical-economic characteristic of current basis-bolus insulin therapy schemes in diabetes mellitus type 1 in adults
Abstract
Basis-bolus insulin therapy is a cornerstone of Diabetes Mellitus type 1 (DM1T) control. Basal insulin analogs — glargine 300 U/ml (iGla 300), glargine 100 U/ml (iGla 100), detemir (iDet) degludec (iDeg), — as well as prandial insulins — glulisine (iGlu), aspart (iAsp) and lispro — are used widely during last 10–15 years. Aim. Evaluation of a comparative economic efficacy of the different basis-bolus schemes of insulin therapy in DM1T in adults. Materials and methods. Analysis has been performed for the following schemes: iGla 300 + iGlu, iGla 100 + iGlu, iDet+iAsp, iDeg+iAsp from Govt position based on modelling of the efficacy for 5 years. Data regarding probability of complications based on glycated hemoglobin (HbA1c) reduction for human insulin treatment and insulin analogs were taken into modelling. Direct medical costs were calculated for insulins, complications, hypoglycemic including severe events. Sensitivity analysis has been performed for validation of the received results. Results: Insulin analogs have economic advantages in compare with human insulins for DM1T control for 6.5 years. They could reduce expenditures in 1.89 times. iGla 300 + iGlu and iDeg+iGlu reduced HbA1c more effective among analogs and hypo events were more rare also (35.0 episodes/patient/year), including severe (0.57 and 0.70 episodes/patient/ year accordingly) vs iGla 100 + iGlu and iDet+iAsp (37.8 and 39.9 episodes/patient/year and 1.10 and 1.21 episodes/patient/ year for severe accordingly). Calculated direct medical costs were less for iGla 300 + iGlu, after that were following iGla 100 + iGlu, iDet+iAsp and last (highest) were expenditures for iDeg+iAsp. Conclusion. Created model prognoses complications of DM1T depending on schemes of insulin therapy and calculates of direct costs. iGla 300 + iGlu has economic advantages vs iGla100 + iGlu, iDet+iAsp and iDeg+iAsp in DM1T control during 5 years horizon.
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