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Biphasic Insulin Aspart 30 Vs. Nph Plus Regular Human Insulin in Type 2 Diabetes Patients; a Cost-Effectiveness Study Publisher Pubmed



Farshchi A1 ; Aghili R2 ; Oskuee M3 ; Rashed M3 ; Noshad S4 ; Kebriaeezadeh A1 ; Kia M5 ; Esteghamati A4
Authors
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Authors Affiliations
  1. 1. Tehran University of Medical Sciences, Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran, Iran
  2. 2. Iran University of Medical Sciences, Endocrine Research Center, Institute of Endocrinology and Metabolism, Tehran, Iran
  3. 3. Islamic Azad University, Pharmaceutical Sciences branch, Tehran, Iran
  4. 4. Tehran University of Medical Sciences, Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, P.O. Box 13145-784, Tehran, Iran
  5. 5. Tehran University of Medical Sciences, Department of Internal Medicine, Dr. Ziaeian Hospital, Tehran, Iran

Source: BMC Endocrine Disorders Published:2016


Abstract

Background: The aim of this study was to compare the efficacy, safety, costs, and cost-effectiveness of biphasic insulin aspart 30 (BIAsp 30) with NPH plus regular human insulin (NPH/Reg) in patients with type 2 diabetes mellitus (T2DM). Methods: It was a Single-center, parallel-group, randomized, clinical trial (Trial Registration: NCT01889095). One hundred and seventy four T2DM patients with poorly controlled diabetes (HbA1c ≥ 8 % (63.9 mmol/mol)) were randomly assigned to trial arms (BIAsp 30 and NPH/Reg) and were followed up for 48 weeks. BIAsp 30 was started at an initial dose of 0.2-0.6 IU/Kg in two divided doses and was titrated according to the glycemic status of the patient. Similarly, NPH/Reg insulin was initiated at a dose of 0.2-0.6 IU/Kg with a 2:1 ratio and was subsequently titrated. Level of glycemic control, hypoglycemic events, direct and indirect costs, quality adjusted life year (QALY) and incremental cost-effectiveness ratio have been assessed. Results: HbA1c, Fasting plasma glucose (FPG), and two-hour post-prandial glucose (PPG) were improved in both groups during the study (P < 0.05 for all analyses). Lower frequencies of minor, major, and nocturnal hypoglycemic episodes were observed with BIAsp 30 (P < 0.05). Additionally, BIAsp 30 was associated with less weight gain and also higher QALYs (P < 0.05). Total medical and non-medical costs were significantly lower with BIAsp 30 as compared with NPH/Reg (930.55 ± 81.43 USD vs. 1101.24 ± 165.49 USD, P = 0.004). Moreover, BIAsp 30 showed lower ICER as a dominant alternative. Conclusions: Despite being more expensive, BIAsp 30 offers the same glycemic control as to NPH/Reg dose-dependently and also appears to cause fewer hypoglycemic events and to be more cost-effective in Iranian patients with type 2 diabetes. © 2016 The Author(s).
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