OBJECTIVES

To evaluate the costs and health outcomes of using Insulin Degludec/Aspart compared to Biphasic Insulin Aspart in treating patients with Type 2 Diabetes Mellitus (T2DM) in Iran.

METHODS

An economic evaluation was performed based on three-state Markov modelling to calculate the cost per quality-adjusted life year (QALY) gained.A four-day cycle length and a 5-year time horizon were applied. The model was run with data on transition probabilities between glycemic states, mortality risks, utility weights, and hypoglycemia event cost. A systematic review was conducted in order to evaluate the clinical effectiveness of the comparators. Relative randomized controlled trials, based on the inclusion criteria, were included. Treatment effect data including change in glycozilated hemoglobin (HbA1c), insulin daily dose and hypoglycemia events were extracted. Direct medical, non-medical and indirect costs were calculated using official health tariffs book of Iran and medical chart of hospitalized patients. Costs were calculated from a payer and societal perspective. Dollar currency rate was considered 42000 IRR/1USD. A 5% and 3% discount rates were used for costs and QALYs respectively. One-way sensitivity analysis was performed for assessing the robustness of the model.

RESULTS

Insulin Degludec/Aspart was associated with a negative incremental cost-effectiveness ratio (ICER) from both payer and societal perspective and, considered as a dominant choice. In One-way sensitivity analyses with changing the unit cost of hypoglycemia event or unit cost of medicine, rates of hypoglycemia and disutilities of hypoglycemic event, the ICER remains in the acceptable range.

CONCLUSIONS

Our model showed that Insulin Degludec/Aspart is a cost-effective treatment compared with Insulin Biphasic Aspart in patients with Type 2 diabetes. Using Insulin Degludec/Aspart is associated with significant reductions in severe hypoglycemia and insulin dose. Although the Insulin Degludec/Aspart is more expensive than the comparator arm, this difference has been diminished due to high costs associated with hypoglycemia management in Iran.