The Cost-Effectiveness Of Intermediate-Acting, Long-Acting, Ultralong-Acting, and Biosimilar Insulins for Type 1 Diabetes Mellitus: A Systematic Review

• Published in: Value in health 2022-07, Vol.25 (7), p.1235-1252
• Main Authors: Saunders, Hailey, MSc, Pham, Ba’, PhD, Loong, Desmond, MSc, Mishra, Sujata, MA, Ashoor, Huda M., BSc, Antony, Jesmin, MSc, Darvesh, Nazia, MSc, Bains, Silkan K., BSc, Jamieson, Margaret, BIE, Plett, Donna, MSc, Trivedi, Srushhti, MHSc, Yu, Catherine H., MD, MHSc, Straus, Sharon E., MD, MSc, Tricco, Andrea C., PhD, MSc, Isaranuwatchai, Wanrudee, PhD
• Format: Article
• Language: English
• Subjects: adults; cost-effectiveness; insulin; Internal Medicine; knowledge synthesis; systematic review; type 1 diabetes mellitus
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2021.12.016

AbstractObjectivesThe incidence of type 1 diabetes mellitus is increasing every year requiring substantial expenditure on treatment and complications. A systematic review was conducted on the cost-effectiveness of insulin formulations, including ultralong-, long-, or intermediate-acting insulin, and their biosimilar insulin equivalents. MethodsMEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, HTA, and NHS EED were searched from inception to June 11, 2021. Cost-effectiveness and cost-utility analyses were included if insulin formulations in adults (≥ 16 years) with type 1 diabetes mellitus were evaluated. Two reviewers independently screened titles, abstracts, and full-text articles, extracted study data, and appraised their quality using the Drummond 10-item checklist. Costs were converted to 2020 US dollars adjusting for inflation and purchasing power parity across currencies. ResultsA total of 27 studies were included. Incremental cost-effectiveness ratios ranged widely across the studies. All pairwise comparisons (11 of 11, 100%) found that ultralong-acting insulin was cost-effective compared with other long-acting insulins, including a long-acting biosimilar. Most pairwise comparisons (24 of 27, 89%) concluded that long-acting insulin was cost-effective compared with intermediate-acting insulin. Few studies compared long-acting insulins with one another. ConclusionsLong-acting insulin may be cost-effective compared with intermediate-acting insulin. Future studies should directly compare biosimilar options and long-acting insulin options and evaluate the long-term consequences of ultralong-acting insulins.