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1.
Curr Med Res Opin ; 34(2): 369-375, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29172837

RESUMEN

OBJECTIVE: To assess the financial consequences of different adoption rate of Biphasic Insulin Aspart (BIAsp) 30 instead of Biphasic Human Insulin (BHI) 30 for people with type 2 diabetes (T2DM) in Thailand from the payer's perspective. METHODS: The Excel-based International T2DM Budget Impact Model over a 3-year period was used. The cohort was the T2DM patients who received treatment from government hospitals under the Universal Health Coverage Scheme. Demographic, the adverse events, and the costs were derived from published studies in Thailand. Efficacy was based on meta-analysis. Adoption rates were assumed to increase each year. Net budget impact (NBI) and one-way sensitivity were analyzed. RESULTS: Hypoglycemia costs were lower in BIAsp 30 compared with BHI 30. The NBI per year was 26,511,269 THB (771,349 USD) for year 1, 52,181,133 THB (1,518,218 USD) for year 2, and 76,189,608 THB (2,216,747 USD) for year 3. The NBI per insulin user per year was 33.45 THB (0.97 USD), 67.27 THB (1.96 USD), 101.49 THB (2.95 USD) from year 1 to year 3, respectively Conclusions: Lower rate of hypoglycemia with BIAsp 30 than those treated with BHI 30 generates cost savings resulting in significant deduction in the additional acquisition cost of BIAsp 30. Therefore, the NBI per insulin user per year has become small.


Asunto(s)
Insulinas Bifásicas , Diabetes Mellitus Tipo 2 , Hipoglucemia , Insulina Aspart , Insulina Isófana , Insulinas Bifásicas/administración & dosificación , Insulinas Bifásicas/efectos adversos , Insulinas Bifásicas/economía , Presupuestos/métodos , Presupuestos/estadística & datos numéricos , Estudios de Cohortes , Ahorro de Costo/estadística & datos numéricos , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/epidemiología , Hipoglucemia/prevención & control , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/economía , Insulina Aspart/administración & dosificación , Insulina Aspart/efectos adversos , Insulina Aspart/economía , Insulina Isófana/administración & dosificación , Insulina Isófana/efectos adversos , Insulina Isófana/economía , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Tailandia/epidemiología , Resultado del Tratamiento
2.
East Mediterr Health J ; 21(10): 729-35, 2015 Dec 13.
Artículo en Inglés | MEDLINE | ID: mdl-26750163

RESUMEN

Despite their reported benefits in terms of glycaemic control, insulin analogues are expensive for patients in developing countries. This study in Jordan aimed to compare the effectiveness and adverse events of premixed human insulin (BHI30) versus premixed insulin analogue (BIAsp30) in patients with type 2 diabetes. In a retrospective cohort study from October 2012 to March 2013, outcomes (HbA1c, weight, hypoglycaemia and lipohypertrophy) were compared at baseline and 6 months after treatment in 628 patients. BHI30 produced a significantly greater reduction in HbA1c than did BIAsp30. This difference in HbA1c remained significant after controlling for the effects of age, sex, duration of diabetes, body mass index and hypoglycaemia (ß-coefficient was -0.18 in favour of BHI30). Weight gain and mild hypoglycaemia was significantly higher with BHI30 than with BIAsp30. BHI30 achieved better reduction in HbA1c compared with BIAsp30, with less cost, slightly more weight gain and greater reported mild hypoglycaemia.


Asunto(s)
Insulinas Bifásicas/uso terapéutico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Insulina Aspart/uso terapéutico , Insulina Isófana/uso terapéutico , Insulina/uso terapéutico , Anciano , Insulinas Bifásicas/economía , Países en Desarrollo , Femenino , Humanos , Hipoglucemiantes/economía , Insulina/economía , Insulina Aspart/economía , Insulina Isófana/economía , Jordania , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
3.
J Med Econ ; 18(4): 263-72, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25426701

RESUMEN

AIMS: The aim of this analysis was to assess the cost-effectiveness of switching from biphasic human insulin 30 (BHI), insulin glargine (IGlar), or neutral protamine Hagedorn (NPH) insulin (all ± oral glucose-lowering drugs [OGLDs]) to biphasic insulin aspart 30 (BIAsp 30) in people with type 2 diabetes in India, Indonesia, and Saudi Arabia. METHODS: The IMS CORE Diabetes Model was used to determine the clinical outcome, costs, and cost-effectiveness of switching from treatment with BHI, IGlar, or NPH to BIAsp 30 over a 30-year time horizon. A 1-year analysis was also performed based on quality-of-life data and treatment costs. Incremental cost-effectiveness ratios (ICERs) were expressed as a fraction of gross domestic product (GDP) per capita, and cost-effectiveness was defined as ICER <3-times GDP per capita. RESULTS: Switching treatment from BHI, IGlar, or NPH to BIAsp 30 was associated with an increase in life expectancy of >0.7 years, reduction in all diabetes-related complications, and was considered as cost-effective or highly cost-effective in India, Indonesia, and Saudi Arabia (BHI to BIAsp 30, 0.26 in India, 1.25 in Indonesia, 0.01 in Saudi Arabia; IGlar to BIAsp 30, -0.68 in India, -0.21 in Saudi Arabia; NPH to BIAsp 30, 0.15 in India, -0.07 in Saudi Arabia; GDP per head per annum/quality-adjusted life-year). Cost-effectiveness was maintained in the 1-year analyses. CONCLUSIONS: Switching from treatment with BHI, IGlar, or NPH to BIAsp 30 (all ± OGLDs) was found to be cost-effective in India, Indonesia, and Saudi Arabia, both in the long and short term.


Asunto(s)
Complicaciones de la Diabetes/economía , Diabetes Mellitus Tipo 2/economía , Insulinas/economía , Esperanza de Vida/tendencias , Anciano , Insulinas Bifásicas/economía , Insulinas Bifásicas/uso terapéutico , Análisis Costo-Beneficio , Complicaciones de la Diabetes/epidemiología , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Combinación de Medicamentos , Femenino , Humanos , Hipoglucemiantes/clasificación , Hipoglucemiantes/economía , Hipoglucemiantes/uso terapéutico , Incidencia , India/epidemiología , Indonesia/epidemiología , Insulina Aspart/economía , Insulina Aspart/uso terapéutico , Insulina Glargina/economía , Insulina Glargina/uso terapéutico , Insulina Isófana/economía , Insulina Isófana/uso terapéutico , Insulinas/clasificación , Insulinas/uso terapéutico , Masculino , Persona de Mediana Edad , Calidad de Vida , Arabia Saudita/epidemiología
4.
Prim Care Diabetes ; 9(5): 370-6, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25488587

RESUMEN

AIMS: Investigate efficacy and tolerability of intensifying diabetes treatment with once- or twice-daily biphasic insulin aspart 30 (BIAsp 30) added to sitagliptin, and twice-daily BIAsp 30 without sitagliptin in patients with type 2 diabetes (T2D) inadequately controlled on sitagliptin. METHODS: Open-label, three-arm, 24-week trial; 582 insulin-naïve patients were randomized to twice-daily BIAsp 30+sitagliptin (BIAsp BID+Sit), once-daily BIAsp 30+sitagliptin (BIAsp QD+Sit) or twice-daily BIAsp 30 without sitagliptin (BIAsp BID), all with metformin. RESULTS: After 24 weeks, HbA1c reduction (%) was superior with BIAsp BID+Sit vs. BIAsp QD+Sit (BIAsp BID+Sit minus BIAsp QD+Sit difference: -0.36 [95% CI -0.54; -0.17], P<0.001) and BIAsp BID (BIAsp BID minus BIAsp BID+Sit difference: 0.24 [0.06; 0.43], P=0.01). Observed final HbA1c values were 6.9%, 7.2% and 7.1% (baseline 8.4%), and 59.8%, 46.5% and 49.7% of patients achieved HbA1c <7.0%, respectively. Confirmed hypoglycaemia was lower with BIAsp QD+Sit vs. BIAsp BID (P=0.015); rate: 1.17 (BIAsp QD+Sit), 1.50 (BIAsp BID+Sit) and 2.24 (BIAsp BID) episodes/patient-year. Difference in bodyweight change favoured BIAsp QD+Sit vs. both BID groups (P<0.001). CONCLUSIONS: Adding BIAsp 30 to patients with T2D poorly controlled with sitagliptin and metformin is efficacious and well tolerated; however, while BIAsp BID+Sit showed superior glycaemic control, BIAsp QD+Sit had a lower rate of hypoglycaemia and showed no weight gain.


Asunto(s)
Insulinas Bifásicas/administración & dosificación , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/administración & dosificación , Insulina Aspart/administración & dosificación , Insulina Isófana/administración & dosificación , Metformina/administración & dosificación , Fosfato de Sitagliptina/administración & dosificación , Anciano , Asia , Australia , Biomarcadores/sangre , Insulinas Bifásicas/efectos adversos , Insulinas Bifásicas/economía , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/economía , Esquema de Medicación , Costos de los Medicamentos , Quimioterapia Combinada , Europa (Continente) , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/economía , Insulina Aspart/efectos adversos , Insulina Aspart/economía , Insulina Isófana/efectos adversos , Insulina Isófana/economía , Masculino , Metformina/efectos adversos , Metformina/economía , Persona de Mediana Edad , Fosfato de Sitagliptina/efectos adversos , Fosfato de Sitagliptina/economía , América del Sur , Factores de Tiempo , Resultado del Tratamiento
5.
Diabetes Res Clin Pract ; 106(2): 319-27, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25305133

RESUMEN

AIM: This study aimed to assess the cost-effectiveness of starting insulin therapy with biphasic insulin aspart 30 (BIAsp 30) in people with type 2 diabetes inadequately controlled on oral glucose-lowering drugs in Saudi Arabia, India, Indonesia, and Algeria. METHODS: The IMS CORE Diabetes Model was used to evaluate economic outcomes associated with starting BIAsp 30, using baseline characteristics and treatment outcomes from the A(1)chieve study. Time horizons of 1 and 30 years were applied, with country-specific costs for complications, therapies, and background mortality. Incremental cost-effectiveness ratios (ICERs) are expressed as cost per quality-adjusted life-year (QALY) in local currencies, USD, and fractions of local GDP per capita (GDPc). Cost-effectiveness was pre-defined using the World Health Organization definition of <3.0 times GDPc. Comprehensive sensitivity analyses were performed. RESULTS: In the primary 30-year analyses, starting BIAsp 30 was associated with a projected increase in life expectancy of >1 year and was highly cost-effective, with ICERs of -0.03 (Saudi Arabia), 0.25 (India), 0.48 (India), 0.47 (Indonesia), and 0.46 (Algeria) GDPc/QALY. The relative risk of developing selected complications was reduced in all countries. Sensitivity analyses including cost of self-monitoring, treatment costs, and deterioration of glucose control with time showed the results to be robust. In a 1-year analysis, ICER per QALY gained was still cost-effective or highly cost-effective. CONCLUSION: Starting BIAsp 30 in people with type 2 diabetes in the A(1)chieve study was found to be cost-effective across all country settings at 1- and 30-year time horizons, and usefully increased predicted life expectancy.


Asunto(s)
Insulinas Bifásicas/economía , Diabetes Mellitus Tipo 2/economía , Hipoglucemiantes/economía , Insulina Aspart/economía , Insulina Isófana/economía , Adulto , Anciano , Argelia , Enfermedades Autoinmunes , Insulinas Bifásicas/uso terapéutico , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Femenino , Hemoglobina Glucada/metabolismo , Costos de la Atención en Salud , Humanos , Hipoglucemiantes/uso terapéutico , India , Indonesia , Insulina Aspart/uso terapéutico , Insulina Isófana/uso terapéutico , Esperanza de Vida , Masculino , Persona de Mediana Edad , Años de Vida Ajustados por Calidad de Vida , Arabia Saudita , Factores de Tiempo , Resultado del Tratamiento
6.
Diabetes Technol Ther ; 14(3): 244-50, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22047050

RESUMEN

BACKGROUND: The present study evaluated the efficacy of biphasic human insulin 30 (BHI 30) in type 2 diabetes patients who had failed in therapy with two or more oral antidiabetes drugs (OADs). METHODS: This open-label, nonrandomized, 4-month, multicenter, clinical observational study was conducted in Shanghai, China. A total of 660 insulin-naive type 2 diabetes patients with poor glycemic control (glycosylated hemoglobin [HbA1c] ≥7.5%), despite treatment with two or more OADs for more than 6 months, were recruited and received BHI 30 monotherapy or BHI 30 plus OAD(s) (metformin only, α-glucosidase inhibitor only, or both). RESULTS: Among the 660 subjects, 644 completed the 4-month study. At the end of the study, the median level of HbA1c decreased by 2.0% (from 9.1% to 7.0%) in the BHI 30 monotherapy group and also 2.0% (from 9.5% to 7.3%) in the BHI 30 plus OAD group. More patients achieved the HbA1c <7.0% target in the BHI 30 monotherapy group than in the BHI 30 plus OAD(s) group (47.9% vs. 35.3%, P=0.002). Compared with the expenses of the prior treatment strategy, the median daily cost decreased by 39.8% (4.5 yuan, Chinese RMB) at the end point in the BHI 30 monotherapy group but increased by 20.0% (2.2 yuan) in the BHI 30 plus OAD(s) group (P<0.0001). Moreover, patients in the BHI 30 plus OAD(s) group had fewer minor hypoglycemic episodes than in the BHI 30 monotherapy group (mean of 1.06 vs. 2.77 per patient per year, P<0.0001). CONCLUSIONS: Short-term BHI 30 therapy can improve glycemic control in insulin-naive type 2 diabetes patients after failure of two or more OADs. With higher baseline glucose level, the BHI 30 plus OAD(s) group had lower pharmacoeconomic efficacy than the BHI 30 monotherapy group despite having fewer hypoglycemia events.


Asunto(s)
Insulinas Bifásicas/administración & dosificación , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemia/prevención & control , Hipoglucemiantes/administración & dosificación , Metformina/administración & dosificación , Anciano , Insulinas Bifásicas/economía , Glucemia/efectos de los fármacos , Glucemia/metabolismo , China/epidemiología , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Hemoglobina Glucada/efectos de los fármacos , Hemoglobina Glucada/metabolismo , Humanos , Hipoglucemia/sangre , Hipoglucemia/epidemiología , Hipoglucemiantes/economía , Masculino , Metformina/economía , Persona de Mediana Edad , Distribución por Sexo , Insuficiencia del Tratamiento , Aumento de Peso/efectos de los fármacos
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