OBJECTIVES: As healthcare spending on diabetes and its complications continues to rise, the optimization of prescribed insulin regimens is becoming increasingly important from both clinical and economic perspectives. Not only the prevalence of diabetes is high in Iran, but also the rate of diabetes complications is relatively high due to uncontrolled glucose level. The aim of this study is to assess the cost-effectiveness of Insulin Lispro/Lispro protamin 50/50 (IL50/50) versus Insulin Aspart/ Aspart protamin 30/70 (IA30/70) in diabetic patients type II in Iran.

METHODS: A systematic review was conducted in electronic databases up to August 2017. Results of fixed method meta-analysis showed no statistically significant difference between IL50/50 and IA30/70 in the case of HbA1c change as an indicator of clinical efficacy. So, Cost-Minimization Analysis (CMA) was applied for economic evaluation from a payer perspective using one year decision tree model. The model was fed with assumptions of the same price for both products and the same therapeutic procedure for them. Direct medical costs including pharmacy, complication, adverse events, and patient management costs were calculated in local currency _Iranian Rial (IRR) _ and sensitivity analyses were performed.

RESULTS: Based on the meta-analysis, both insulin products showed the same efficacy. However, based on literature, the average annual dosage of these two type of products is slightly different. Furthermore, IL50/50 was associated with higher rate of nephropathy-related death and led to total costs of IRR 14,773,298 annually. In addition, IA30/70 was associated with higher rate of angina and led to annual costs of IRR 16,371,640. The result indicated that although IL50/50 andIA30/70 have the same therapeutic efficacy, IL50/50 would lead to IRR 1,598,343 cost saving over one year time horizon.

CONCLUSIONS: Insulin Mix Lispro 50/50 would be a dominant strategy compared to Insulin Mix Aspart 30/70 assuming the same product price.