OBJECTIVE: To evaluate the annual direct pharmacy costs-per-patient for reaching the goal of an A1C of <7.0% and = 6.5% among patients with type-2 diabetes using oral antidiabetic agents (OADs) and either biphasic insulin aspart 70/30 (BIAsp 70/30) or glargine. METHODS: Data from a recent clinical study (INITIATE) demonstrated that over a 28-week period, significantly more insulin-naïve, type-2 subjects previously treated with OADs reached the American Diabetes Association target of A1C<7.0% with twice-daily BIAsp 70/30 + metformin (met) ± thiazolidinedione (TZD) compared to bedtime insulin glargine + met ± TZD (66% vs. 40%; p=0.0002). Likewise, a statistically significant difference favoring BIAsp 70/30 was observed when assessing the two cohorts against the International Diabetes Federation target of A1C = 6.5% (42% vs. 28%; p=0.0356). The annual direct pharmacy costs for the insulins, metformin, and TZD (pioglitazone) were calculated using published AWP cost data within the US. RESULTS: Cost calculations were based on end-of-study mean daily medication doses of 0.82 IU/kg BIAsp 70/30 (mean weight: 95.7 kg), 0.55 IU/kg glargine (mean weight: 93.8 kg), 1500 mg metformin, and 30 mg pioglitazone for subjects treated with TZD (32% in each arm). The mean costs-per-patient reaching A1C values of <7.0% were $5295 with BIAsp 70/30 and $6850 with glargine, and $8321 and $9786, respectively, for subjects reaching = 6.5%. CONCLUSION: The mean annual direct pharmacy costs-per-patient were considerably lower using BIAsp 70/30 compared to glargine, indicating that BIAsp 70/30 is a better investment of health care dollars when aiming to bring type-2 patients to better control at clinically endorsed A1C targets.