OBJECTIVES: Second-generation basal insulins like insulin glargine 300 U/mL (Gla-300) have a longer duration of action and less intra-day fluctuation and inter-day variability than first-generation ones, such as glargine 100 U/mL (Gla-100). The EF-BI study, a nationwide observational, retrospective study, was designed to compare the total costs of care associated with the initiation of such basal insulins (BI) in real-life setting in France.

METHODS: This study was conducted using the national French administrative healthcare claims database (SNDS). Adult patients living with Type 1 or Type 2 Diabetes Mellitus (T1DM or T2DM) who initiated a basal insulin scheme with Gla-300 or Gla-100 ± other diabetes treatment between January 1, 2016, and December 31, 2020, and without insulin therapy in the previous 6 months were included.

Comparisons of total costs were established for patients treated continuously with basal insulin over one to three years after propensity score adjustment on initial patient/treatment characteristics. Costs were estimated in both a collective perspective and the National Sickness Fund one.

RESULTS: A total of 235,894 patients with T2DM and 6,672 patients with T1DM were included. Patient characteristics vary significantly according to the type of basal insulin used in both populations. Comparison of adjusted collective costs (hospital and outpatient costs) following initiation showed moderate but statistically significant differences in favor of Gla-300 versus Gla-100 insulins for all patients (T1DM and T2DM) over the first year, and for T2DM over the entire 3-year follow-up. Switching all patients initiating Gla-100 over a three-year period to Gla-300 would have resulted in a reduction of health expenditure by 473 million € for the National Sickness Fund only.

CONCLUSIONS: Adjusted cost comparisons show a significant reduction in total expenditure with Gla-300 versus Gla-100 over the three years studied for T2DM and over the first year for T1DM.