Cost-effectiveness of insulin analogs from the perspective of the Brazilian public health system

• Published in: Brazilian Journal of Pharmaceutical Sciences Vol. 53; no. 3
• Main Authors: Cazarim, Maurílio de Souza, Rodrigues, João Paulo Vilela, Cruz-Cazarim, Estael Luzia Coelho da, Ayres, Lorena Rocha, Pereira, Leonardo Régis Leira
• Format: Journal Article
• Language: English; Portuguese
• Published: Sao Paulo Universidade de Sao Paulo Faculdade de Ciencias 01.01.2017; Universidade de São Paulo, Faculdade de Ciências Farmacêuticas; Universidade de São Paulo
• Subjects: Brazilian Public Health System; Confidence intervals; Cost analysis; Cost control; Decision making; Decision trees; Diabetes; Diabetes Mellitus/treatment/cost-effectiveness/evaluation; Insulin; Meta-analysis; Patients; PHARMACOLOGY & PHARMACY; Probability; Prolonged Action Insulin; Public health; Sensitivity analysis; Short Action Insulin; Brazil; Diabetes Mellitus/treatment/cost-effectiveness/evaluation; Brazilian Public Health System; Prolonged Action Insulin; Short Action Insulin
• ISSN: 1984-8250; 2175-9790; 1984-8250; 2175-9790
• DOI: 10.1590/s2175-97902017000300178

Human insulin is provided by the Brazilian Public Health System (BPHS) for the treatment of diabetes, however, legal proceedings to acquire insulin analogs have burdened the BPHS health system. The aim of this study was to perform a cost-effectiveness analysis to compare insulin analogs and human insulins. This is a pharmacoeconomic study of cost-effectiveness. The direct medical cost related to insulin extracted from the Ministry of Health drug price list was considered. The clinical results, i.e. reduction in glycated hemoglobin (HbA1c), were extracted by meta-analysis. Different scenarios were structured to measure the uncertainties regarding the costs and reduction in HbA1c. Decision tree was developed for sensitivity of Incremental Cost Effectiveness Ratio (ICER). A total of fifteen scenarios were structured. Given the best-case scenario for the insulin analogs, the insulins aspart, lispro, glargine and detemir showed an ICER of R$ 1,768.59; R$ 3,308.54; R$ 11,718.75 and R$ 2,685.22, respectively. In all scenarios in which the minimum effectiveness was proposed, lispro, glargine and detemir were dominant strategies. Sensitivity analysis showed that the aspart had R$ 3,066.98 [95 % CI: 2339.22; 4418.53] and detemir had R$ 6,163.97 [95% CI: 3919.29; 11401.57] for incremental costs. We concluded there was evidence that the insulin aspart is the most cost-effective.