Systematic review of the cost-effectiveness of insulin in the treatment of type 2 diabetes

Vo Ngoc Yen Nhi; Pham Luong Son; Nguyen Tan Dung; Nguyen Thi Thu Thuy

doi:10.59294/HIUJS20250116

Từ khóa:

systematic review, insulin, cost-effectiveness

Tóm tắt

Background: Type 2 diabetes mellitus (T2DM) is a major chronic disease requiring lifelong treatment. Insulin therapies play a key role in glycemic control, but their cost-effectiveness varies widely across formulations and delivery methods. Objectives: Systematic review of the cost-effectiveness of insulin in the treatment of type 2 diabetes. Materials and methods: A systematic review (SR) following PRISMA guidelines searched PubMed, Cochrane, Embase, and Vietnamese journals up to December 4, 2024. Eligible studies met predefined criteria and were appraised using the CHEERS 2022 checklist. Cost data and ICERs were converted to 2024 USD for comparison. Results: From 7,873 records, 84 studies were included (3 on delivery forms, 5 on injection methods, and 76 on insulin molecules). Thirteen recent studies (2020 onward) were analyzed for comparisons between insulin molecules; most (12/13) used model-based analysis and were high-quality. Insulin degludec was cost-effective or dominant compared with other basal insulins; icodec saved 480 - 974 USD and gained 0.04 - 0.08 QALYs compared with degludec. Glargine 100 was cost-effective compared with NPH (ICER 424 - 21,590 USD) and dominant over detemir. Pen devices improved adherence and glycemic control despite higher costs; insulin pumps were more cost-effective than multiple daily injections (ICER 64,433 - 104,069 USD/QALY). Stepwise initiation saved 3,370 USD and added 0.08 QALYs. Conclusions: The SR confirmed the cost-effectiveness of new insulin therapies and provides valuable evidence for future pharmacoeconomic evaluations.

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a major chronic disease requiring lifelong treatment. Insulin therapies play a key role in glycemic control, but their cost-effectiveness varies widely across formulations and delivery methods. Objectives: Systematic review of the cost-effectiveness of insulin in the treatment of type 2 diabetes. Materials and methods: A systematic review (SR) following PRISMA guidelines searched PubMed, Cochrane, Embase, and Vietnamese journals up to December 4, 2024. Eligible studies met predefined criteria and were appraised using the CHEERS 2022 checklist. Cost data and ICERs were converted to 2024 USD for comparison. Results: From 7,873 records, 84 studies were included (3 on delivery forms, 5 on injection methods, and 76 on insulin molecules). Thirteen recent studies (2020 onward) were analyzed for comparisons between insulin molecules; most (12/13) used model-based analysis and were high-quality. Insulin degludec was cost-effective or dominant compared with other basal insulins; icodec saved 480 - 974 USD and gained 0.04 - 0.08 QALYs compared with degludec. Glargine 100 was cost-effective compared with NPH (ICER 424 - 21,590 USD) and dominant over detemir. Pen devices improved adherence and glycemic control despite higher costs; insulin pumps were more cost-effective than multiple daily injections (ICER 64,433 - 104,069 USD/QALY). Stepwise initiation saved 3,370 USD and added 0.08 QALYs. Conclusions: The SR confirmed the cost-effectiveness of new insulin therapies and provides valuable evidence for future pharmacoeconomic evaluations.

Tài liệu tham khảo

[1] P. Saeedi, I. Salpea, S. Karuranga, … and L. Williams, “Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045…,” Diabetes Research and Clinical Practice, vol. 157, p. 107843, 2019.

[2] T. Vos, S. Lim, C. Abbafati, … and C.J.L. Murray, “Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019,” The Lancet, vol. 396, no. 10258, pp. 1204-1222, 2020.

[3] N.L. Viet, H.T.T. Huyen, N.T.T. Huong, P.D. Thu and V.N.Y. Nhi, “Analysis of direct medical costs in the treatment of type 2 diabetes in Hanoi in 2022,” Hong Bang International University Journal of Science, pp. 197-202, 2023. [in Vietnamese].

[4] M.J. Page, J.E. McKenzie, P.M. Bossuyt, … and D. Moher, “PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews,” BMJ, vol. 372, p. n160, 2021.

[5] D. Husereau, M. Drummond, F. Augustovski, … and S. Staniszewska, “Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: Updated reporting guidance for health economic evaluations,” Value in Health, vol. 25, no. 1, pp. 3-9, 2022.

[6] Shemilt, T. James and M. Marcello, “A web-based tool for adjusting costs to a specific target currency and price year,” Evidence & Policy, vol. 6, no. 1, pp. 51-59, 2010.

[7] W.C. Lee, S. Balu, D. Cobden, A.V. Joshi and C.L. Pashos, “Medication adherence and the associated health-economic impact among patients with type 2 diabetes mellitus converting to insulin pen therapy: an analysis of third-party managed care claims data,” Clinical Therapeutics, vol. 28, no. 10, pp. 1712-1725, 2006.

[8] D. Cobden, W.C. Lee, S. Balu, A.V. Joshi and C.L. Pashos, “Health outcomes and economic impact of therapy conversion to a biphasic insulin analog pen among privately insured patients with type 2 diabetes mellitus,” Pharmacotherapy, vol. 27, no. 7, pp. 948-962, 2007.

[9] P. Lasalvia, J.E. Barahona-C, D. Romero, … and D. Rosselli, “Cost-effectiveness of pen devices for NPH insulin administration compared with syringe and vial in adult patients with diabetes mellitus in Colombia” Value in Health, vol. 18, no. 7, p. A359, 2015.

[10] A.B.M. Kamrul-Hasan, M.A. Hannan, M.S. Alam, … and S. Selim, “Comparison of simplicity, convenience, safety, and cost-effectiveness between use of insulin pen devices and disposable plastic syringes by patients with type 2 diabetes mellitus: a cross-sectional study from Bangladesh,” BMC Endocrine Disorders, vol. 23, no. 1, p. 37, 2023.

[11] N. Wake, A. Hisashige, T. Katayama, … and M. Shichiri, “Cost-effectiveness of intensive insulin therapy for type 2 diabetes: a 10-year follow-up of the Kumamoto study,” Diabetes Research and Clinical Practice, vol. 48, no. 3, pp. 201-210, 2000.

[12] R. Saunders, J. Lian, B. Karolicki, and W. Valentine, "The cost-effectiveness and budget impact of stepwise addition of bolus insulin in the treatment of type 2 diabetes: evaluation of the FullSTEP trial," J Med Econ, vol. 17, no. 12, pp. 827-36, Dec 2014.

[13] W.J. Valentine, B.H. Curtis, R.F. Pollock, … and D.M. Kendall, “Is the current standard of care leading to cost-effective outcomes for patients with type 2 diabetes requiring insulin? A long-term health economic analysis for the UK,” Diabetes Research and Clinical Practice, vol. 109, no. 1, pp. 95-103, 2015.

[14] S. Roze, E. Duteil, J. Smith-Palmer, … and H.W. de Valk, “Cost-effectiveness of continuous subcutaneous insulin infusion in people with type 2 diabetes in the Netherlands,” Journal of Medical Economics, vol. 19, no. 8, pp. 742-749, 2016.

[15] S. Roze, J. Smith-Palmer, A. Delbaere, … and M. Honkasalo, “Cost-effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections in patients with poorly controlled type 2 diabetes in Finland,” Diabetes Therapy, vol. 10, no. 2, pp. 563-574, 2019.

[16] E.M.M. Gkrinia, A.K. Faour, A. Belančić, … and D. Vitezić, “A systematic review of economic evaluations of insulin for the management of type 2 diabetes,” Diabetology, vol. 4, no. 4, pp. 440-452, 2023.

[17] P. McEwan and M. Evans, “The health economics of insulin therapy: how do we address the rising demands, costs, inequalities and barriers to achieving optimal outcomes,” Diabetes, Obesity and Metabolism, vol. 27, suppl. 5, pp. 24-35, 2025.

[18] P. Lasalvia, J.E. Barahona-Correa, D.M. Romero-Alvernia, … and D. Rosselli, “Pen devices for insulin self-administration compared with needle and vial: systematic review of the literature and meta-analysis,” Journal of Diabetes Science and Technology, vol. 10, no. 4, pp. 959-966, 2016.

[19] Cranston, V. Jamdade, B. Liao and R.S. Newson, “Clinical, economic, and patient-reported benefits of connected insulin pen systems: a systematic literature review,” Advances in Therapy, vol. 40, no. 5, pp. 2015-2037, 2023.