The prescription cost of managing people with type 1 and type 2 diabetes following initiation of treatment with either insulin glargine or insulin detemir in routine general practice in the UK: a retrospective database analysis

Background: Two alternative basal analogue insulin treatments are available: insulin glargine (glargine) and insulin detemir (detemir). There are differences between these alternatives that could correspondingly result in differing financial costs of treatment. The purpose of this study was to compare the costs of diabetes-related treatments, administration and monitoring following initiation of treatment with glargine or detemir regimens in people with type 1 or type 2 diabetes mellitus in the UK. Methods: The source data were a proprietary database of people treated in general practice in the UK (The Health Improvement Network (THIN)). Unit prices were from published sources. Data were extracted for people initiated on one of these two insulin regimens following the UK launch of detemir in June 2004. Where necessary, data were standardised. Results: The two patient cohorts were well matched. The median annual cost of treatment with glargine and detemir for people with type 1 diabetes was £1198 versus £1330 (Δ = 10%; p <0.001), respectively. For type 2 diabetes, the comparative values were £1014 and £1410 (Δ = 28%; p < 0.001), respectively. In type 1 diabetes, a glargine-based regimen resulted consistently in reduced costs of treatment: insulin (9%; p = 0.001), reagents (13%; p = 0.035), hypoglycaemia rescue medication (25%; p = 0.052), pen delivery devices (40%; p = 0.001) and sharps (25%; p = 0.053). In type 2 diabetes, a glargine-based regimen also resulted consistently in reduced costs of treatment: insulin (32%; p < 0.001), reagents (16%; p = 0.002), hypoglycaemia rescue medication (34%; p = 0.260), pen delivery devices (40%; p < 0.001) and sharps (17%; p = 0.006). Furthermore, there was no statistically significant increase in cost of treatment with oral hypoglycaemic agents using a glargine-based regimen. Conclusion: Diabetes management with glargine results in markedly reduced costs of diabetes-related treatment compared with detemir in people with type 1 or type 2 diabetes