Cost-comparison between different treatment regimens in diabetes mellitus in Germany based on long acting insulins

Objective: The objective of this evaluation is a cost comparison between different basal insulin regimens (glargine vs. detemir vs. NPH-insulin) in diabetic patients in Germany under real-life conditions.

Methods: The current analysis is based on IMS LRx-database (2012) which allows a long-term tracking of prescriptions of anonymised patients insured in the statutory health insurance (GKV) in Germany. Patients with at least one prescription of basal insulin (insulin glargine or insulin detemir or NPH-insulin) in 2009 or 2010 and at least one prescription in 2011 (January – December) were considered elegible for the analysis. The costs were estimated by ex pharmacy prices (Lauer Taxe) minus legally defined rebates of pharmaceutical companies (§130 a SGB V). The treatment costs were calculated for the total SHI-population and breakdowns at the level of eight sick fund groups. In addition single cost component analysis were performed. The descriptive analysis was carried out with SPSS version 19 giving parameters like means, standard deviation, minimal and maximal values, confidence intervals, percentile values.

Results: The database provides data of 542,438 patients which were allocated to the different basal insulin groups: 207,506 patients in the glargine group, 90,671 patients in the detemir group and 244,261 patients in the NPH insulin group. The mean annual treatment costs per patient of glargine (1,211 €) and NPH insulin (1,224 €) are comparable whereas the detemir treatment cost are 23 – 28% higher (1,572 €). If the GKV-population is breakdown at the level of different sick funds a similar pattern of annual treatment costs per patient of the three basal insulin regimens is obtained. Detemir treatment is most expensive for all sick funds whereas glargine and NPH treatment groups are almost at a comparable level. The drug costs of basal insulin is considerably higher for glargine (380 €) and detemir (448 €) compared to NPH-Insulin (253 €). The cost of bolus insulin is lower in the glargine group (305 €, bolus human and bolus insulin analog) compared to NPH-insulin (419 €) whereas the detemir group disclosed the highest costs 493 € for bolus insulin. Another component with strong impact on total costs is the consumption of test strips. The costs due to different application rates is lowest in the in the glargine group (342 €) compared to detemir (436 €) and NPH insulin (401 €.)

Conclusion: In conclusion, insulin glargine regimens with annual total costs of 1,211 € are comparable with a NPH-based regimens (1,224 €) for treatment of type 2 diabetes mellitus whereas an insulin detemir based regimens (1,572 €) is 23 – 28% more expensive. The large database tool gives a precise picture of real life costs of antidiabetic treatment for patients requiring basal insulin regimens insured by SHI sick funds.

The study was supported by Sanofi-Aventis Germany, Berlin