Cost-effectiveness of Biphasic insulin aspart 70/30 vs. insuline glargine in the US

Jinender Kumar

Question 1

Was a well-defined question posed in answerable form? – Yes.

◦To project the long term clinical and economic outcome of treatment with biphasic insulin aspart 30 vs. insulin glagrine in insulin naïve type 2 diabetes failing to achieve glycemic control with oral anti-diabetic agent alone.

Question 2

Was a comprehensive description of the competing alternatives given? – Yes.◦BIAsp 70/30 twice daily: fasting plasma

glucose (FPG) < 180 mg/dl, 10 units daily; FPG ≥ 180 mg/dl, 12 units daily.insulin glargine once dailytarget FPG and evening glucose values: 80-110 mg/dl

Question 3Was there evidence that the

programs' effectiveness had been established? – Yes.

◦INITIATE study was done through a randomized, controlled clinical trial. The effectiveness was established.

Question 4Were all important and relevant

costs and consequences for each alternative identified? – Yes.◦The range was wide enough for the

research question at hand.◦It is from the perspective of a third-

party payer.

Question 5

Were costs and consequences measured accurately in appropriate physical units prior to valuation? – Yes.◦Any identified items were not omitted

from measurement.◦There were some special circumstances

that made measurement difficult such as cost per event of diabetes-related complications. These circumstances were handled appropriately.

Question 6

Were costs and consequences valued credibly? – Yes.

◦The sources of all values were clearly identified.

◦The valuation of consequences was appropriate for the question posed. Cost-effectiveness was selected to be the appropriate type of analysis.

Question 7

Were costs and consequences adjusted for differential timing? – Yes.

◦Costs and consequences were that occurred in the future "discounted" to their present values.

Question 8

Was an incremental analysis of costs and consequences of alternatives performed? – Yes.◦The additional (incremental) costs

generated by the use of one alternative over another was compared with the additional effects, benefits or utilities generated.

◦Incremental cost-effectiveness ratio (ICER): lifetime ICER, and ICER in patients with baseline HbA1c ≥ 8.5%

Question 9Was a sensitivity analysis

performed? – Yes.

◦Justification was provided for the ranges of values (for key parameters) used in the sensitivity analysis.

◦The study results were not sensitive to changes in the values (within the assumed range).

Question 10Did the presentation and

discussion of the results of the study include all issues of concern to users? – Yes.

◦The conclusions of the analysis were based on cost-effectiveness ratio.

◦The study discussed the generalizability of the results to other settings and patient groups.