Cost Change After Initiating Basal Insulin for 6 Months in Patients with Type 2 Diabetes: A Registry Study in China
International Journal of Diabetes and Endocrinology
Volume 4, Issue 3, September 2019, Pages: 62-72
Received: Jul. 18, 2019;
Accepted: Aug. 13, 2019;
Published: Sep. 3, 2019
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Dongshan Zhu, Diabetes Research Program, The George Institute for Global Health at Peking University Health Science Center, Beijing, P. R. China; School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
Xian Li, Biostatistics & Economic Evaluation Program, The George Institute for Global Health at Peking University Health Science Center, Beijing, P. R. China
Jiachao Ji, Biostatistics & Economic Evaluation Program, The George Institute for Global Health at Peking University Health Science Center, Beijing, P. R. China
Juming Lu, Department of Endocrinology, The General Hospital of the People's Liberation Army, Beijing, P. R. China
Weiping Jia, Department of Endocrinology, Shanghai Sixth People’s Hospital, Shanghai, P. R. China
Linong Ji, Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, P. R. China
Puhong Zhang, Diabetes Research Program, The George Institute for Global Health at Peking University Health Science Center, Beijing, P. R. China
This study aims to examine short-term treatment cost changes after initiating basal insulin in insulin naïve patients with type 2 diabetes for 6 months in routine clinical practice. Observational Registry of Basal Insulin Treatment (ORBIT) program is a 6-month, prospective study in China. Patients with type 2 diabetes inadequately controlled (HbA1C≥7%) by oral antidiabetic drugs (OADs) and willing to initiate basal insulin treatment were enrolled from 209 hospitals of eight geographic regions of China. Type and dose of BI were at the physician’s discretion and patients’ willingness. Interviews were conducted at baseline, month 3 and month 6. Daily treatment cost (including cost of OAD medication, insulin therapy, self-monitoring of blood glucose and dealing with minor hypoglycemia) of per person before and after adding BIs was evaluated. After adding on Basal insulin, the weighted mean ± standard deviation (SD) daily treatment cost for insulin-naïve patients with type 2 diabetes increased from $1.25 ± $0.74 (baseline) to $2.57 ± $0.68 at month 6, a median (Q1, Q3) increase of 1.51 (0.38, 4.11) times over 6 months. The daily treatment cost increased with growing baseline HbA1c level and prolonged diabetes duration. The reduction in HbA1c was 2.2%, with minor hypoglycemia increased by 0.68 times/person/year. Insulin cost accounted for the highest proportion (47.9%) of costs. Our findings suggest adding-on BI therapy may increase the daily treatment cost by 1.5 times at 6 months. Early initiation of BI therapy may provide an opportunity to achieve treatment goals with low cost and low risk of hypoglycemia.
Cost Change After Initiating Basal Insulin for 6 Months in Patients with Type 2 Diabetes: A Registry Study in China, International Journal of Diabetes and Endocrinology.
Vol. 4, No. 3,
2019, pp. 62-72.
Guariguata L, Whiting DR, Hambleton I, et al. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract 2014; 103: 137-149.
Li H, Oldenburg B, Chamberlain C, et al. Diabetes prevalence and determinants in adults in China mainland from 2000 to 2010: a systematic review. Diabetes Res Clin Pract 2012; 98: 226-235.
Yang SH, Dou KF, Song WJ. Prevalence of diabetes among men and women in China. N Engl J Med 2010; 362: 2425-2426; author reply 2426.
Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults. JAMA 2013; 310: 948-959.
Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998; 15: 539-553.
Hanefeld M. Use of insulin in type 2 diabetes: what we learned from recent clinical trials on the benefits of early insulin initiation. Diabetes Metab 2014; 40: 391-399.
Turner RC, Cull CA, Frighi V, et al. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. JAMA 1999; 281: 2005-2012.
Garber AJ. Treat-to-target trials: uses, interpretation and review of concepts. Diabetes Obes Metab 2014; 16: 193-205.
Holman RR, Farmer AJ, Davies MJ, et al. Three-year efficacy of complex insulin regimens in type 2 diabetes. N Engl J Med 2009; 361: 1736-1747.
Khunti K, Caputo S, Damci T, et al. The safety and efficacy of adding once-daily insulin detemir to oral hypoglycaemic agents in patients with type 2 diabetes in a clinical practice setting in 10 countries. Diabetes Obes Metab 2012; 14: 1129-1136.
Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care 2013; 36: 1384-1395.
Tsai ST, Pathan F, Ji L, et al. First insulinization with basal insulin in patients with Type 2 diabetes in a real-world setting in Asia. J Diabetes 2011; 3: 208-216.
Hermansen K, Davies M, Derezinski T, et al. A 26-week, randomized, parallel, treat-to-target trial comparing insulin detemir with NPH insulin as add-on therapy to oral glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetes Care 2006; 29: 1269-1274.
Philis-Tsimikas A, Charpentier G, Clauson P, et al. Comparison of once-daily insulin detemir with NPH insulin added to a regimen of oral antidiabetic drugs in poorly controlled type 2 diabetes. Clin Ther 2006; 28: 1569-1581.
Riddle MC, Rosenstock J, Gerich J, et al. The treat-to-target trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabetes Care 2003; 26: 3080-3086.
Rosenstock J, Davies M, Home PD, et al. A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetologia 2008; 51: 408-416.
Yki-Järvinen H, Kauppinen-Mäkelin R, Tiikkainen M, et al. Insulin glargine or NPH combined with metformin in type 2 diabetes: the LANMET study. Diabetologia 2006; 49: 442-451.
Dornhorst A, Lüddeke HJ, Sreenan S, et al. Insulin detemir improves glycaemic control without weight gain in insulin-naive patients with type 2 diabetes: subgroup analysis from the PREDICTIVE study. Int J Clin Pract 2008; 62: 659-665.
Hajos TR, Pouwer F, de Grooth R, et al. Initiation of insulin glargine in patients with Type 2 diabetes in suboptimal glycaemic control positively impacts health-related quality of life. A prospective cohort study in primary care. Diabet Med 2011; 28: 1096-1102.
Home P, Naggar NE, Khamseh M, et al. An observational non-interventional study of people with diabetes beginning or changed to insulin analogue therapy in non-Western countries: the A1chieve study. Diabetes Res Clin Pract 2011; 94: 352-363.
Marre M, Pinget M, Gin H, et al. Insulin detemir improves glycaemic control with less hypoglycaemia and no weight gain: 52-week data from the PREDICTIVE study in a cohort of French patients with type 1 or type 2 diabetes. Diabetes Metab 2009; 35: 469-475.
Schreiber SA, Ferlinz K, Haak T. The long-term efficacy of insulin glargine plus oral antidiabetic agents in a 32-month observational study of everyday clinical practice. Diabetes Technol Ther 2008; 10: 121-127.
Borah BJ, Darkow T, Bouchard J, et al. A comparison of insulin use, glycemic control, and health care costs with insulin detemir and insulin glargine in insulin-naive patients with type 2 diabetes. Clin Ther 2009; 31: 623-631.
Gschwend MH, Aagren M, Valentine WJ. Cost-effectiveness of insulin detemir compared with neutral protamine Hagedorn insulin in patients with type 1 diabetes using a basal-bolus regimen in five European countries. J Med Econ 2009; 12: 114-123.
Ridderstråle M, Jensen MM, Gjesing RP, et al. Cost-effectiveness of insulin detemir compared with NPH insulin in people with type 2 diabetes in Denmark, Finland, Norway, and Sweden. J Med Econ 2013; 16: 468-478.
Valentine WJ, Erny-Albrecht KM, Ray JA, et al. Therapy conversion to insulin detemir among patients with type 2 diabetes treated with oral agents: a modeling study of cost-effectiveness in the United States. Adv Ther 2007; 24: 273-290.
Yang L, Christensen T, Sun F, et al. Cost-effectiveness of switching patients with type 2 diabetes from insulin glargine to insulin detemir in Chinese setting: a health economic model based on the PREDICTIVE study. Value Health 2012; 15: S56-59.
Home P, Baik SH, Gálvez GG, et al. An analysis of the cost-effectiveness of starting insulin detemir in insulin-naïve people with type 2 diabetes. Journal of medical economics 2015; 18: 230-240.
Cardoso C, Ramirez de Arellano A, Prades M, et al. Cost-effectiveness Analysis of Insulin Detemir Compared to Neutral Protamine Hagedorn (NPH) in Patients with Type 1 and Type 2 Diabetes Mellitus in Portugal. JOURNAL OF DIABETES & METABOLISM 2016; 7.
Ji L, Zhang P, Weng J, et al. Observational Registry of Basal Insulin Treatment (ORBIT) in Patients with Type 2 Diabetes Uncontrolled by Oral Hypoglycemic Agents in China-Study Design and Baseline Characteristics. Diabetes Technol Ther 2015; 17: 735-744.
Zheng Y, Wu J, Xie K. Incidence and cost of hypoglycemia episode in patients with type 2 diabetes mellitus. Chinese rural health service administration 2012; 32: 1195-1198.
Zhou M, Astell-Burt T, Bi Y, et al. Geographical variation in diabetes prevalence and detection in china: multilevel spatial analysis of 98,058 adults. Diabetes Care 2015; 38: 72-81.
National Bureau of Statistics of China. 2010 China population census 2010. http://www.stats.gov.cn/tjsj/pcsj/rkpc/6rp/indexch.htm. Accessed April 30, 2017.
Kim SS, Kim IJ, Kim YK, et al. Duration of diabetes and effectiveness of insulin in the management of insulin-naïve Korean patients uncontrolled on oral antidiabetic drugs: a sub-analysis of the MOdaliTy of Insulin treatment eValuation (MOTIV) registry results. Acta Diabetol 2014; 51: 655-661.
Yeaw J, Lee WC, Wolden ML, et al. Cost of Self-Monitoring of Blood Glucose in Canada among Patients on an Insulin Regimen for Diabetes. Diabetes Ther 2012; 3: 7.
Yeaw J, Lee WC, Aagren M, et al. Cost of self-monitoring of blood glucose in the United States among patients on an insulin regimen for diabetes. J Manag Care Pharm 2012; 18: 21-32.
Nilchaikovit T, Hill JM, Holland JC. The effects of culture on illness behavior and medical care. Asian and American differences. Gen Hosp Psychiatry 1993; 15: 41-50.