OBJECTIVES: As the prevalence of type 2 diabetes is reaching epidemic proportions worldwide and diabetes is associated with costly micro- and macrovascular complications, long-term cost effectiveness of diabetes therapies is becoming a public health priority. Given the large price difference between human and analogue basal insulins, the main objectives of present study were to investigate long-term health outcomes and costs in patients initiated on basal insulin supported oral therapy(BOT) using human or analogue insulins. METHODS: The Claims Database of the National Health Insurance Fund of Hungary covers all publicly financed inpatient and outpatient events in Hungary (e.g. diagnoses, medication use, medical aids & devices). For the current analyses, we created cohort study of all type 2 diabetes patients initiated on BOT therapy and followed them up between 01.01.2009 and 12.31.2016. We compared patients on human and analogue BOT using an intention to treat approach. Beside a comprehensive descriptive, inferential statistics and cost analyses, we used propensity score matching to compare the trajectories of diabetes therapies and the incidence of disease-related comorbidities and complications. RESULTS: We found a significant benefit of analogue based BOT over human based BOT in patients free of macrovascular complications at baseline in regards the incidence of cardiovascular and cerebrovascular events (RR=0.55, CI: 0.4 – 0.75, p=0.01; RR=0.71, CI: 0.57 – 0.89, p=0.01 respectively). The incremental cost-effectiveness ratio was 2.2 and 4.6 Million HUF per avoided cardio- and cerebrovascular events in analogue BOT compared to human BOT therapy. CONCLUSIONS: Despite the higher medication cost of analogue based BOT, this therapeutic approach was associated with a substantial reduction in the risk of macrovascular complications and an acceptable cost-effectiveness compared to human insulin based BOT. Further investigations are needed to describe patient subgroups that would gain the most benefit from the analogue BOT approach.