ABSTRACT
In the LAPTOP trial, combination therapy with once-daily insulin glargine + oral antidiabetic agents glimepiride and metformin (BOT) was compared to twice-daily premixed insulin (CT). BOT was safer and more effective than CT. Cost analysis of both regimens were compared over a 1-year period. Analyses were performed from the perspective of the German statutory health insurance. Costs per patient per year were on average 236euro lower for BOT than for CT therapy. Economic advantage for BOT was robust to variation of expenses within a range of at least +/-20%. Insulin utilisation and prices were the major cost drivers, followed by costs associated with monitoring of blood glucose levels. Cost analysis of the LAPTOP trial suggest that BOT is more cost effective alternative to CT.
Subject(s)
Diabetes Mellitus, Type 2/economics , Hypoglycemic Agents/economics , Insulin/analogs & derivatives , Insulin/economics , Metformin/economics , Sulfonylurea Compounds/economics , Administration, Oral , Cost-Benefit Analysis , Diabetes Mellitus, Type 2/drug therapy , Drug Therapy, Combination , Germany , Health Care Costs/statistics & numerical data , Humans , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Insulin Glargine , Insulin, Long-Acting , Metformin/administration & dosage , National Health Programs , Randomized Controlled Trials as Topic , Sulfonylurea Compounds/administration & dosageABSTRACT
Primary antibody deficiencies are the most common forms of primary immunodeficiencies. Substitution therapy with polyvalent immunoglobulins has been established as the standard therapy for antibody deficiencies for several decades. Until now mainly intravenous immunoglobulins (IVIG) have been used in Germany, and the majority of patients receive treatment in hospital outpatient clinics. In recent years subcutaneous administration of immunoglobulins (SCIG) has been developed which is administered as home self-infusion. Studies indicate no significant differences in immunoglobulin substitution therapy between SCIG and IVIG concerning outcome. We carried out a cost-minimization analysis to compare the two treatment alternatives in Germany. Under base case assumptions the treatment with SCIG is cost saving from the perspective of the German statutory health insurance. The main cost drivers are IVIG and SCIG; the incremental cost of SCIG compared to IVIG is most sensitive to changes in the immunoglobulin price and changes in the body weight of the patient.
