A Cost Comparison of a Basal-Bolus Regimen Vs. Premixed Insulin in Type 2's

GINGER (Glulisine in Combination with Insulin Glargine in an Intensified Insulin Regimen) was a 52-week open label multinational study in 310 type 2 diabetes patients A_1C 7.5-11.0% treated with insulin ± metformin who were randomly allocated to a basal-bolus (glargine-glulisine) regimen or to continue with two injections per day of premixed insulin (neutral protamine hagedorn + regular insulin/insulin aspart). The cost analysis, comparing glargine-glulisine with biphasic insulin aspart (BIA) substituted for both premixes, was undertaken from a UK National Health Service perspective.

The annual insulin cost per patient on glargine-glulisine ($1088) was higher than BIA ($932). The cost of needles, lancets and test strips was lower for BIA than for glargine-glulisine due to fewer injections. The total annual cost per patient receiving glargine-glulisine was $1960 compared with $1478 for BIA. Over 52 weeks the relative cost of a 1% reduction in HbA_1C was $1497 for glargine-glulisine and $1848 for BIA.

This cost analysis of the GINGER study demonstrates that a similar reduction in HbA_1C and FPG may be achieved at a relatively lower cost with glargine-glulisine than with BIA. Despite the higher costs for the glargine-glulisine regimen it may provide payers with better value for money due to its better glycemic control. It may also allow primary care physicians to achieve the stricter QOF targets for HbA_1C at a relatively lower cost compared with other treatment options.