OBJECTIVES: To compare the direct treatment costs in insulin-naïve type-2-diabetics (T2D) starting a basal supported oral therapy (BOT) with either insulin glargine (GLA) or NPH-insulin (NPH) over 10 years focusing on the different persistence to these regimens. METHODS: A cost-minimization approach was applied. The analysis was conducted from the German statutory health insurance (SHI) perspective. A Markov model was developed simulating the onset of a BOT with GLA or NPH at a ratio of 1:1 and thereafter switching to an intensified conventional therapy (ICT) with the same basal insulin in the course of 10 years. Persistence data were obtained from the IMS Disease Analyzer database [1] considering the first 6 months after starting BOT as titration phase. Cost data were derived from a German cost evaluation in an ambulatory setting [2] (cost base year 2005). As only costs were considered, no discounting was applied. RESULTS: In the first year after initiating a BOT, costs per patient are slightly higher (+ €3.25) in GLA- than NPH-based regimens. From year two GLA regimens show an increasing cost advantage compared to NPH up to -€1,217 per patient after 10 years. As all patients have changed to ICT at year 10, a longer time horizon would not change the findings. Calculated for an estimated cohort of 44,366 German T2D covered by the SHI and starting a BOT with GLA (50%) or NPH (50%), the total costs over 10 years are €169.7 vs. €223.7 million, respectively. CONCLUSIONS: Due to a longer persistence to a basal supported oral therapy in T2D, long-term costs of GLA are lower compared to NPH. Therefore, initiating an insulin therapy using BOT with GLA leads to potential cost savings of €54 million per 10 years for the German SHI. References: [1] Diabetologie und Stoffwechsel 2009;4:1-6 [2] J Med Econ 2008;11:695-712.