OBJECTIVES: To assess the cost-effectiveness (CE) of switching from biphasic human insulin 30 (BHI 30) ± oral glucose-lowering drugs (OADs) to biphasic insulin aspart 30 (BIAsp 30) ± OADs in people with type 2 diabetes (T2D) in countries in different economic circumstances based on observational data gathered in routine clinical practice. METHODS: The A1chieve® study assessed safety and outcomes over 24 weeks in 66,726 people with T2D starting insulin analog therapy. The CE analyses included people switching to BIAsp 30 in Saudi Arabia (n=401), India (n=866) and Indonesia and Malaysia based on people in 4 ASEAN countries (n=175). Data were collected on clinical effectiveness, adverse events, and outcomes using the EQ-5D questionnaire. CE analyses used the IMS CORE diabetes model with 1 and 30 year time horizons, with country-specific costs for complications and therapies and background mortality rates. Incremental cost-effectiveness ratios (ICERs) are expressed as cost/QALY in local currencies, USD and in fractions of local GDP per capita based on switching from BHI 30 to BIAsp 30. CE was pre-defined as <3*GDP.  RESULTS: One-year ICERs were: Saudi Arabia (SAR 12,913; USD 3,443; GDP 0.17), India (INR 36,001; USD 649; GDP 0.44), Indonesia (IDR 120,507,714; USD 12,520; GDP 2.92), Malaysia (MYR 40,321; USD 13,180; GDP 3.08). 30-year ICERs were: Saudi Arabia (SAR 837; USD 223; 0.03 GDP), India (INR 21,696; USD 391, GDP 0.26), Indonesia (IDR 51,416,633; USD 5,342; GDP 1.25), Malaysia (MYR 19,967; USD 5,342; GDP 1.25). Sensitivity analyses on the 30 year time horizon showed the findings to be robust. CONCLUSIONS: Switching from BHI 30±OADs to BIAsp 30±OADs in T2D as performed in the A1chieve® study was found to be cost-effective across all country settings at 1 and 30 year time horizons.  The Malaysian analyses showed borderline cost-effectiveness using 1 year time horizon but cost-effectiveness assuming 30 year time horizon.