OBJECTIVES: To project the long-term clinical and cost outcomes associated with long-acting insulin analog treatment in patients with type 1 diabetes in an Austrian setting. METHODS: We used a published, validated and peer-reviewed computer simulation model of diabetes to project short-term clinical findings to evaluate long-term outcomes including quality-adjusted life expectancy, complication rates and direct medical costs. Clinical data have been derived from the PREDICTIVE study, an ongoing global post-marketing safety study, for a sub-group of patients with type 1 diabetes receiving long-acting insulin glargine (IGlar) in a basal/bolus treatment regimen at baseline and switched to long-acting insulin detemir (IDet). After 12 weeks of follow up, IDet-based basal/bolus treatment was associated with improvements in HbA1c (0.25%-points lower), reduced risk of hypoglycemic events (by 55%), and decreased body weight (0.27 kg) compared to IGlar-based treatment. Probabilities of complications and HbA1c-dependent adjustments were derived from the DCCT, Framingham, and WESDR studies (amongst others). Costs of treating complications were retrieved from published sources. Total direct costs (complications+treatment costs) were projected over patient lifetimes. Costs and outcomes were discounted at 3.5% per annum. RESULTS: Improved glycemic control, decreased hypoglycemic events and BMI with IDet-based basal/bolus therapy led to fewer diabetes-related complications and an increase in quality-adjusted life expectancy of 0.13 quality-adjusted life years (QALYs). IDet-based therapy was associated with slightly higher lifetime direct costs (€394 per patient) which led to an incremental cost-effectiveness ratio (ICER) of €3,031 per QALY gained. CONCLUSIONS: Short-term clinical benefits associated with IDet-based basal/bolus therapy were projected to lead to improvements in quality-adjusted life expectancy and fewer diabetes related complications than IGlar-based regimens. Incremental cost-effectiveness analysis indicated that, over patient lifetimes, IDet-based combinations would represent good value for money versus IGlar-based therapy in the Austrian setting.