Basal Insulin Regimens for Adults with Type 1 Diabetes Mellitus: A Cost-Utility Analysis

Dalia Dawoud, Elisabetta Fenu, Bernard Higgins, David Wonderling, Stephanie A Amiel

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
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OBJECTIVES: To assess the cost-effectiveness of basal insulin regimens for adults with type 1 diabetes mellitus in England.

METHODS: A cost-utility analysis was conducted in accordance with the National Institute for Health and Care Excellence reference case. The UK National Health Service and personal and social services perspective was used and a 3.5% discount rate was applied for both costs and outcomes. Relative effectiveness estimates were based on a systematic review of published trials and a Bayesian network meta-analysis. The IMS CORE Diabetes Model was used, in which net monetary benefit (NMB) was calculated using a threshold of £20,000 per quality-adjusted life-year (QALY) gained. A wide range of sensitivity analyses were conducted.

RESULTS: Insulin detemir (twice daily) [iDet (bid)] had the highest mean QALY gain (11.09 QALYs) and NMB (£181,456) per patient over the model time horizon. Compared with the lowest cost strategy (insulin neutral protamine Hagedorn once daily), it had an incremental cost-effectiveness ratio of £7844/QALY gained. Insulin glargine (od) [iGlarg (od)] and iDet (od) were ranked as second and third, with NMBs of £180,893 and £180,423, respectively. iDet (bid) remained the most cost-effective treatment in all the sensitivity analyses performed except when high doses were assumed (>30% increment compared with other regimens), where iGlarg (od) ranked first.

CONCLUSIONS: iDet (bid) is the most cost-effective regimen, providing the highest QALY gain and NMB. iGlarg (od) and iDet (od) are possible options for those for whom the iDet (bid) regimen is not acceptable or does not achieve required glycemic control.

Original languageEnglish
Pages (from-to)1279-1287
Number of pages9
JournalValue in Health
Issue number10
Early online date8 Jul 2017
Publication statusPublished - 1 Dec 2017


  • Adult
  • Bayes Theorem
  • Blood Glucose/drug effects
  • Computer Simulation
  • Cost-Benefit Analysis
  • Diabetes Mellitus, Type 1/drug therapy
  • England
  • Female
  • Humans
  • Hypoglycemic Agents/administration & dosage
  • Insulin Detemir/administration & dosage
  • Insulin Glargine/administration & dosage
  • Insulin, Isophane/administration & dosage
  • Male
  • Middle Aged
  • Models, Economic
  • Quality-Adjusted Life Years
  • Young Adult


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