Diabetes mellitus is one of the largest cost factors in the German healthcare system. In view of increasing service expenditure and stagnating or declining premium income in statutory health insurance (GKV), pharmacoeconomic analyzes are becoming increasingly important. The aim of the LIVE-SPP study (Long Acting Insulin Glargine Versus NPH Cost Evaluation in SPecialized Practices) was the head-to-head comparison of the diabetes-specific total costs per patient and year in insulin-dependent type 2 diabetics (T2D) in a routine care setting received either insulin glargine (GLA)- or NPH-insulin (NPH)-based insulin treatment.

>> As part of a retrospective, non-interventional, multicenter comparative study, the resource consumption of all insulin-dependent type 2 diabetics from 20 practices of diabetologists working as primary care physicians or diabetology-focused practices in the KV North Rhine and Westphalia-Lippe area was measured over the period from January 1, 2003 - recorded March 31, 2006. The data was collected electronically, directly from the practice software (complete survey). All patients (T2D) who had been previously treated with insulin for a maximum of 24 months and had been treated continuously with one of the two comparator therapies (GLA/NPH) for at least 12 months were evaluated. In addition, complete information about at least four consecutive billing quarters had to be available (2). The pharmacoeconomic evaluation was carried out according to the cost minimization approach on the price basis from 2005 from the perspective of the statutory health insurance (GKV). The prescriptions for medicines, needles, blood sugar test strips, lancets, medicinal products and aids, training courses as well as medical measures, specialist referrals and hospital admissions were assessed in monetary terms based on current price lists and fee schedules. The possible influence of the initial variables age, gender, BMI, HbA1c, fasting blood sugar, duration of diabetes, duration of insulin pretreatment, number of diabetic complications and therapy regime (BOT/ICT) on the costs was examined in univariate linear models. The final cost comparison between the treatment alternatives (GLA/NPH) was adjusted for the basic parameters that had shown a significant influence on the costs (covariance analysis). Systematic sensitivity analyzes were carried out to check the significance of the results. For this purpose, the calculations were repeated with varied input data (± 25%).
Results
The 1,024 patients (GLA 512; NPH 512) were on average 62 years old and had the following initial values (mean values): BMI 30.5 kg/m², HbA1c 7.96 %, fasting BG 171 mg/dl, mean duration of diabetes 8 years. 55 % of the patients were male. The average documentation duration was 20.4 months (9.1 - 38.8 months). The two treatment alternatives (GLA/NPH) did not differ in terms of sociodemographic, anamnestic and medical parameters. Only the number of diabetic complications at the beginning of the documentation and the different distribution of the treatment regimens (BOT/ICT) in the two therapy arms (GLA/NPH) had a significant influence on the costs. The average total empirical costs per patient per year were EUR 1,868 [95%CI 1,744-1,993] for insulin glargine and EUR 2,064 [95% 1,923-2,205] for NPH. Adjusted for the number of diabetic complications and the therapy regimens, the total costs per year were EUR 1,133 [95%CI 618-1,648] for insulin glargine and EUR 1,331 [95%CI 1,019-1,644] for NPH. In both arms, the largest share of the total costs was for insulin and for blood glucose self-monitoring. However, the additional costs for the basal insulin analogue were offset by savings in test strips and injection needles. The cost advantage of insulin glargine was maintained even after extensive sensitivity analyzes (± 25%). Similar results were also found in other comparative cost analyzes with insulin glargine (3).
conclusion
Treatment with insulin glargine tends to show an economic advantage over NPH insulin. With insulin glargine, the savings from the point of view of the GKV amounted to EUR 196 (empirical) or EUR 198 (adjusted) per patient and year. The results are thus consistent with the results of other comparable cost surveys in Germany.

by: Prof. Oliver Schöffski, Franz-Werner Dippel, Markus Müller, Lusine Breitscheidel, Prof. Martin Pfohl