PMID- 37662023
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230928
IS  - 2327-2236 (Electronic)
IS  - 2326-697X (Print)
IS  - 2326-697X (Linking)
VI  - 1
IP  - 2
DP  - 2013
TI  - Cost Effectiveness of Insulin Glargine versus Neutral Protamin Hagedorn Insulin 
      in the Treatment of Type 2 Diabetes Patients in Turkey.
PG  - 108-122
LID - 10.36469/9858 [doi]
AB  - Background: Type 2 diabetes mellitus (T2DM) poses a significant burden on 
      population well being and healthcare expenditure in Turkey, with disease 
      prevalence continuing to increase. Insulin treatment is necessary for patients 
      failing to achieve glycaemic control with lifestyle modification or oral 
      antidiabetic drugs. While neutral protamin Hagedorn (NPH) insulin has been 
      traditionally prescribed for insulin introduction, insulin glargine has been 
      shown to reduce glycated hemoglobin (HbA1c) with a more favourable hypoglycaemic 
      profile. Objective: To evaluate the cost-effectiveness of insulin glargine 
      compared to NPH insulin in patients with T2DM in Turkey, from a Social Security 
      Institution perspective. Methods: A previously published discrete event 
      simulation model of T2DM progression was utilised to characterise the 
      cost-effectiveness of insulin glargine in a Turkish population given the benefits 
      observed in clinical practice. Improvements in glycaemic control have been 
      incorporated using data from The Health Improvement Network (THIN) database in 
      the United Kingdom, combined with meta-regression results describing the 
      relationship between hypoglycaemia and glycaemic control. Outcomes were evaluated 
      over a 40-year horizon, and costs and benefits discounted at an annual rate of 
      3.5%. Results are reported in Turksih lira (TL), 2012. Results: Over a lifetime, 
      the Incremental Cost-effectiveness Ratio (ICER) of insulin glargine compared to 
      NPH was 40,101 TL per Quality-adjusted Life Year (QALY). Almost 52 hypoglycaemic 
      events per patient were avoided with the use of insulin glargine compared to NPH, 
      at an incremental lifetime cost of 7,140 TL per patient. The cost-effectiveness 
      of insulin glargine is reduced when modelling only those benefits considered in 
      the trial setting, while the cost-effectiveness profile can be expected to 
      further improve in patients with higher HbA1c levels at baseline. Conclusion: It 
      is difficult to interpret the results of modelling as there is no official 
      cost-effectiveness threshold in Turkey. However, the results may be evaluated 
      using thresholds derived according to methodology proposed by the World Health 
      Organisation (WHO). Insulin glargine is expected to be costeffective compared to 
      NPH insulin, with an ICER below three times the estimated gross domestic product 
      (GDP) per capita; 56,850 TL.
FAU - Satman, Ilhan
AU  - Satman I
AD  - Division of Endocrinology, Faculty of Internal Medicine Istanbul University, 
      Istanbul, Turkey.
FAU - Bennett, Hayley
AU  - Bennett H
AD  - Swansea Centre for Health Economics Swansea University, Swansea, UK.
FAU - Yilmaz, Candeger
AU  - Yilmaz C
AD  - Division of Endocrinology, Faculty of Internal Medicine Ege University, Izmir, 
      Turkey.
FAU - Imamoglu, Sazi
AU  - Imamoglu S
AD  - Division of Endocrinology, Faculty of Internal Medicine Uludag University, Bursa, 
      Turkey.
FAU - Ayvaz, Goksun
AU  - Ayvaz G
AD  - Division of Endocrinology, Faculty of Internal Medicine Gazi University, Ankara, 
      Turkey.
FAU - Comlekci, Abdurrahman
AU  - Comlekci A
AD  - Division of Endocrinology, Faculty of Indernal Medicine Dokuz Eylul University, 
      Izmir, Turkey.
FAU - Ozkaya, Demet
AU  - Ozkaya D
AD  - Sanofi Turkey, Istanbul, Turkey.
FAU - Sahin, Toros
AU  - Sahin T
AD  - Sanofi Turkey, Istanbul, Turkey.
LA  - eng
PT  - Journal Article
DEP - 20130815
PL  - United States
TA  - J Health Econ Outcomes Res
JT  - Journal of health economics and outcomes research
JID - 101648581
PMC - PMC10471392
OTO - NOTNLM
OT  - cost effectiveness
OT  - insulin glargine
OT  - nph insulin
OT  - turkey
OT  - type 2 diabetes
EDAT- 2013/08/15 00:00
MHDA- 2013/08/15 00:01
PMCR- 2013/08/15
CRDT- 2023/09/04 04:35
PHST- 2013/08/15 00:01 [medline]
PHST- 2013/08/15 00:00 [pubmed]
PHST- 2023/09/04 04:35 [entrez]
PHST- 2013/08/15 00:00 [pmc-release]
AID - 9858 [pii]
AID - 10.36469/9858 [doi]
PST - epublish
SO  - J Health Econ Outcomes Res. 2013 Aug 15;1(2):108-122. doi: 10.36469/9858. 
      eCollection 2013.