OBJECTIVES: In the UK, the role of insulin initiation has traditionally been one for specialist (secondary care) diabetes teams (SDT) but this trend is changing with primary care increasingly taking a leading role. In order to appropriately plan services, all relevant costs need to be considered. This analysis compares the estimated costs of insulin initiation using different models of service delivery - combinations of primary vs secondary care initiation and group vs individual sessions. METHODS: Using published UK literature, the resources used for 4 different service models were estimated, associated unit costs attached and total costs estimated over the first 3 months of insulin therapy. RESULTS: In the secondary care led models, average costs were £221 per person for an individual start over the 3 month period. As expected, estimated costs for group start sessions were lower than for individual starts (average £187). In a primary care initiation model, the average per patient costs were only slightly lower (£139 individual start, £190 group start). These costs are higher than the costs of the insulin therapy over the same time period (average £120) and key cost components were resources of associated health care professionals (HCP) and length of sessions with the relevant HCP, commonly assumed to be a diabetes specialist nurse CONCLUSION: Details of the range of resources used at the point of insulin initiation are not readily available in the literature. This analysis suggests that significant resources are required compared with the medication costs over this initiation period. The amount of time spent with the range of appropriate HCPs is the key driver of cost. Many other factors need consideration when deciding upon appropriate service models including the experience of the HCPs, the complexity of the insulin regimen and the degree of self-ownership and satisfaction by the patient.