OBJECTIVES: Intensive insulin treatment is associated with an increased risk of hypoglycemic events in type 1 diabetes. A recent 26-week randomized clinical trial demonstrated that basal/bolus treatment of type 1 diabetic patients with insulin detemir+insulin aspart (IDet/IAsp), compared to insulin glargine+insulin aspart (IGlar/IAsp), led to a 72% lower risk of major hypoglycemic events (p<0.05). METHODS: A validated model was used to project long-term complications, quality-adjusted life expectancy, long-term direct and indirect costs, and incremental cost-utility ratios (ICURs) for IDet/IAsp versus IGlar/IAsp in Austria and Germany. Markov modeling was used to describe the incidence and progression of complications (cardiovascular disease, neuropathy, renal and eye disease). Probabilities of complications were derived from the DCCT, Framingham, and WESDR studies. Clinical input was taken from the 26-week multicenter, multinational, open-label trial. Costs were retrieved from published sources. Direct and indirect costs of diabetes complications and treatment with IDet/IAsp or IGlar/IAsp were projected over patients' lifetimes from a societal health care perspective. Costs and outcomes were discounted at 3.5% annually. RESULTS: In this analysis, a reduction in major hypoglycemic events associated with IDet/IAsp led to an increase in quality-adjusted life expectancy of 0.11 quality-adjusted life years (QALYs). Direct lifetime costs were slightly higher with IDet/IAsp treatment than with IGlar/IAsp treatment, leading to ICURs of €21,455 per QALY gained in Austria and €13,607 per QALY gained in Germany. When indirect costs were included in the analysis, IDet/IAsp was dominant to IGlar/IAsp in both countries. CONCLUSIONS: IDet/IAsp therapy was associated with improved quality-adjusted life expectancy, leading to an ICUR based on direct costs that was well within the range considered to represent good value for money in Austria and Germany.