OBJECTIVES: This cost analysis, based on the results of the GINGER study, aimed to investigate whether an intensified insulin regimen is better value than a 2 injection per day conventional regimen. METHODS: GINGER was a 52 week multi-national study in 310 T2D patients on insulin for an average of 5 years with poor glycaemic control. It compared mealtime rapid-acting insulin glulisine (IGL) and insulin glargine (IG) once daily with 2 injections per day of pre-mixed insulin. Use of IGL/IG resulted in a change of HbA1C from baseline to endpoint of -1.31% and -0.80% for pre-mixed insulin. Costs were calculated from a UK NHS perspective using MIMS November 2010 prices. Insulin costs were based on the use of IGL/IG (Apidra SoloStar and Lantus SoloStar) and biphasic insulin aspart (BIA, NovoMix 30 FlexPen) prefilled disposable injection devices. It was assumed that a new needle, lancet and blood glucose test strip were used for each injection with a 2U priming dose of insulin before each injection. RESULTS: The annual drug cost per patient on IGL/IG was higher than BIA at £692 and £612 respectively with the cost of metformin similar for both groups. The cost of needles, lancets and test strips was much lower for BIA at £329 compared with £537 for the IGL/IG group. Overall the total annual cost per patient for the IGL/IG group was £1243 compared with £957 for BIA. Over the 52 weeks the relative cost of a 1% reduction in HbA1C was £949 for IGL/IG and £1197 for BIA, a 1mmol/l reduction in FPG was £518 with IGL/IG and £563 with BIA. Sensitivity analyses replacing BIA by insulin lispro or isophane insulin gave very similar results. CONCLUSIONS: A similar reduction in HbA1C and FPG can be achieved at a relatively lower cost with IGL/IG in comparison with BIA.