Systematic Review of the Cost-Effectiveness of Insulin Therapies in the Treatment of Type 2 Diabetes
Author(s)
Võ Nhi, MS, Thuy Thi Thu Nguyen, MBA, PhD.
Hong Bang International University, Ho Chi Minh, Viet Nam.
Hong Bang International University, Ho Chi Minh, Viet Nam.
OBJECTIVES: To systematically review the cost-effectiveness of insulin therapies in type 2 diabetes treatment
METHODS: Systematic review (SR) followed PRISMA guidelines, with searches conducted in PubMed, Cochrane, Embase, and Vietnamese journals up to December 4, 2024. Studies were selected based on predefined criteria and assessed using the CHEERS checklist. Data on study characteristics, methods, and outcomes were extracted, with cost parameters and ICERs converted to 2024 USD.
RESULTS: From 7,873 records, 84 studies met the inclusion criteria. Three compared insulin delivery forms (pen vs. vial), five compared injection methods, and 76 compared insulin molecules. For the cost-effectiveness comparisons between insulin molecules, the review focused on studies published from 2020 onward to ensure data relevance (13 studies). Quality assessment using the CHEERS 2022 checklist showed that the included studies were of good or higher quality. Comparative studies between active pharmaceutical ingredients have been conducted in many countries around the world, including two studies carried out in Vietnam, with modeling methods applied in the majority of cases (12 out of 13 studies). Insulin degludec was found to be cost-effective or dominant compared to other basal insulins (n=3). Insulin icodec showed both cost savings (USD 479.96-974.01) and improved outcomes (0.04-0.08 QALYs) versus insulin degludec. Insulin glargine 100 was cost-effective compared to NPH insulin (ICERs USD 423.85-21,589.82) and dominant over insulin detemir. Pen-based delivery, while more expensive than vials, improved adherence and glycemic control. Continuous subcutaneous insulin infusion was more cost-effective than multiple daily injections (ICERs USD 64,432.51-104,069.15 per QALY). Additionally, stepwise initiation strategies were cost-saving (USD 3,369.90) and resulted in QALY gains (0.08) over full-dose initiation.
CONCLUSIONS: SR highlights the cost-effectiveness of various insulin therapies and offers valuable data for future pharmacoeconomic research. However, studies from Southeast Asia, including Vietnam, remain limited, indicating a need for further regional research.
METHODS: Systematic review (SR) followed PRISMA guidelines, with searches conducted in PubMed, Cochrane, Embase, and Vietnamese journals up to December 4, 2024. Studies were selected based on predefined criteria and assessed using the CHEERS checklist. Data on study characteristics, methods, and outcomes were extracted, with cost parameters and ICERs converted to 2024 USD.
RESULTS: From 7,873 records, 84 studies met the inclusion criteria. Three compared insulin delivery forms (pen vs. vial), five compared injection methods, and 76 compared insulin molecules. For the cost-effectiveness comparisons between insulin molecules, the review focused on studies published from 2020 onward to ensure data relevance (13 studies). Quality assessment using the CHEERS 2022 checklist showed that the included studies were of good or higher quality. Comparative studies between active pharmaceutical ingredients have been conducted in many countries around the world, including two studies carried out in Vietnam, with modeling methods applied in the majority of cases (12 out of 13 studies). Insulin degludec was found to be cost-effective or dominant compared to other basal insulins (n=3). Insulin icodec showed both cost savings (USD 479.96-974.01) and improved outcomes (0.04-0.08 QALYs) versus insulin degludec. Insulin glargine 100 was cost-effective compared to NPH insulin (ICERs USD 423.85-21,589.82) and dominant over insulin detemir. Pen-based delivery, while more expensive than vials, improved adherence and glycemic control. Continuous subcutaneous insulin infusion was more cost-effective than multiple daily injections (ICERs USD 64,432.51-104,069.15 per QALY). Additionally, stepwise initiation strategies were cost-saving (USD 3,369.90) and resulted in QALY gains (0.08) over full-dose initiation.
CONCLUSIONS: SR highlights the cost-effectiveness of various insulin therapies and offers valuable data for future pharmacoeconomic research. However, studies from Southeast Asia, including Vietnam, remain limited, indicating a need for further regional research.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE679
Topic
Economic Evaluation
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), No Additional Disease & Conditions/Specialized Treatment Areas