An analysis of the cost-effectiveness of starting insulin detemir in insulin-naïve people with type 2 diabetes
Posted on 24 November 2015
Summary of findings
In Algeria, this study suggest that adding insulin detemir to uncontrolled type 2 diabetes patients on oral glucose lowering drugs is cost effective in long term compared to continuing oral glucose lowering drugs, according to WHO CHOICES criteria for cost effective intervention.
The incremental cost-effectiveness ratio was 4625 US dollar/QALY gained over 30-year (equivalent to 0.88 Gross Domestic Product per capita).
This economic value is likely to reflect the improvement in metabolic outcome in the A1chieve study population together with improvements in measures in health related quality of life in this study.
Oral glucose lowering drugs
Type 2 diabetes mellitus
Type 2 diabetes patients uncontrolled on oral glucose lowering drugs in Algeria
Country of the study
Public healthcare perspective in Algeria
Long term analysis = 30-year time horizon
Short term analysis = 1-year time horizon
Source of effectiveness
The effectiveness of insulin detemir and oral glucose lowering drugs in Algeria are coming from analysis of data of 473 Algerian patients included in the A1chieve study.
The A1chieve study, an observational multicenter 24-week study in Insulin naïve (n = 44,872) and insulin experienced people (n = 21,854) with T2DM starting biphasic insulin aspart 30, insulin detemir or insulin aspart alone or in combination.
Instrument for utility measure
EQ-5D, quality adjusted life years (QALYs)
Type of cost
Cost associated with diabetes management (annual cost for medications and screening tests) and relevant co-morbid medical conditions (cardiovascular and renal complications, eye-disease, acute event, neuropathy, foot ulcer, amputation)
Source of cost
Literature review, supplement if necessary, review by clinical experts from Algeria. Cost of insulin and oral glucose lowering drugs were obtained from Novo Nordisk in Algeria.
Dinar and US dollar (exchange rate September 2013)
CORE diabetes model
ICER (incremental cost-effectiveness ratio)
30-year ICER (cost per QALY gained)
- 368,200 dinar /QALY gained
- 4625 USD/QALY gained
- Fraction of Gross domestic product per capita = 0.88
1-year ICER (Cost per QALY gained)
- 617,658 dinar /QALY gained
- 7758 USD/QALY gained
- Fraction of Gross domestic product per capita = 1.48
Several sensitivity analyses were performed.
Source of research funding
Home P, Baik SH, Gálvez GG, Malek R, Nikolajsen A. An analysis of the cost-effectiveness of starting insulin detemir in insulin-naïve people with type 2 diabetes. J Med Econ. 2015 Mar;18(3):230-40.