Journal of Diabetology (Jan 2015)
Cost-effectiveness of switching from biphasic human insulin (BHI) to biphasic insulin aspart 30 (BIAsp-30) in type 2 diabetes patients with suboptimal glycaemic control in Singapore
Abstract
The aim of the analysis was to assess the long-term cost-effectiveness of switching from BHI to BIAsp-30 in type 2 diabetes patients with suboptimal glycaemic control in Singapore. Lifetime cost-effectiveness analysis was performed from both societal and healthcare perspectives using the published and validated CORE Diabetes Model. Projected outcomes included quality-adjusted life expectancy, cumulative incidence of complications, direct and indirect costs. Baseline characteristics and treatment effects were derived from the ASEAN cohort analyses of the A1chieve study. Local cost data reported by the Singapore Ministry of Health was used, along with resource use inputs gathered through structured interviews with local key opinion leaders. A 3% discount rate was adopted. All costs were reported in 2013 S$. A series of sensitivity analyses were conducted to test the robustness of the cost-effectiveness results. The base case analysis showed that from both healthcare and societal perspectives, BIAsp-30 was dominant over BHI in poorly controlled diabetes patients. An Incremental benefit of 0.36 quality-adjusted life years was estimated with cost savings of S$14,180 from a healthcare perspective, and S$15,097 from a societal perspective. BIAsp-30 remained dominant over BHI in all the sensitivity analyses except when no difference in hypoglycaemia risk was assumed, where the incremental cost- effectiveness ratio was S$4,675. BIAsp-30 is both a clinically effective and cost-saving treatment for poorly controlled type 2 diabetes patients switching from BHI to BIAsp-30 in the public context of Singapore.
