OBJECTIVES: The OnceMix and INITIATE studies have indicated that biphasic insulin aspart 30 (BIAsp 30) is more effective than insulin glargine (IGlarg) in terms of reductions in glycohemoglobin in type 2 diabetes patients requiring insulin initiation. Our aim was to estimate the cost-effectiveness of BIAsp 30 versus IGlarg in the Chinese setting. METHODS: The previously published IMS Core Diabetes Model was used. The nephropathy, retinopathy and stroke sub-models were modified to incorporate available Chinese clinical data. Diabetes complication costs were derived from hospital surveys in Beijing and Chengdu. Simulated cohorts and insulin treatment effects were based on the OnceMix study for once-daily BIAsp 30 versus IGlarg and on the INITIATE study for twice-daily BIAsp 30 versus IGlarg. Life expectancy and direct societal costs were calculated. Projections were made over 30-year time horizons, with costs and life years discounted at 3% annually. Extensive sensitivity analyses were performed, including adjustments to cardiovascular risk for Chinese ethnicity. RESULTS: Once-daily BIAsp 30 increased life expectancy by 0.04 years (12.37 versus 12.33 years) and reduced direct societal costs by Chinese Yuan (CNY) 59,710 per patient (CNY 229,911 versus CNY 289,621 per patient) compared to IGlarg in the OnceMix-based analysis. Twice-daily BIAsp 30 increased life expectancy by 0.08 years (12.99 versus 12.91 years) and reduced direct societal costs by CNY 107,349 per patient (CNY 303,142 versus CNY 410,491 per patient) compared to IGlarg in the INITIATE-based analysis. Improvements in life expectancy were driven by reduced incidences of most diabetes-related complications. Cost savings were attributable to lower insulin costs for BIAsp 30 compared to IGlarg in China. Lowering cardiovascular risk for Chinese ethnicity reduced the modeled clinical improvements for BIAsp 30 but increased treatment-related cost savings. CONCLUSIONS: BIAsp 30, either once- or twice-daily, improves life expectancy and is cost-saving compared to IGlarg in the Chinese setting.