OBJECTIVES: Based on the clinical results of the LAPTOP trial, a cost analysis from the perspective of the German Statutory Health Insurance (SHI) was performed. In addition a model simulation of the long term complications was conducted using the Diabetes-Mellitus-Model (DMM version 3.2). METHODS: Cost analysis: Costs during the first year of treatment after switching to either BOT (glargine plus glimepirid and metformine) or CT (premixed insulin 30/70) were analysed. Costs for antidiabetic agents, injection devices (pens, syringes) and monitoring devices (test strips, lancets) were included. Other medical supplies were assumed to be the same or not relevant from the SHI perspective. Insulin utilization was extrapolated up to one year by linear regression based on LAPTOP trial data. The cost of drugs, devices and supplies (retail prices) were taken from official standard sources. Univariate sensitivity analyses were performed for all cost parameters (variation ± 20%). DMM-Simulation: Baseline values for the model simulation were as follows: mean age of the population 60 ± 9.0 years, mean duration of diabetes 9.0 ± 7.0 years and mean HbA1c value 8.8 ± 0.9%. The response rate (HbA1c = 7%) for BOT was 49% and for CT 39%. Mean HbA1c values for responders were 6.46% and 6.55% respectively. RESULTS: Annual savings with the BOT regimen add up to 236.35€. Insulin utilization and insulin prices had the highest impact on overall costs. The relative risk reduction (RRR) for micro-vascular events after 10 simulation years varied between 14 % (end stage renal disease) and 2 % (retinopathy) in favour of BOT versus CT. CONCLUSION: The combined results of these two analyses show that BOT in addition to its short (HbA1c) and long term (micro-vascular events) medical benefits is associated with lower costs from the SHI perspective.