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CADTH » Search All Products » Health Technology Assessment » Long-Acting Insulin Analogues for Diabetes Mellitus: Meta-analysis of Clinical Outcomes and Assessment of Cost-Effectiveness

Long-Acting Insulin Analogues for Diabetes Mellitus: Meta-analysis of Clinical Outcomes and Assessment of Cost-Effectiveness

See also CADTH's COMPUS report: Long-Acting Insulin Analogues for the Treatment of Diabetes Mellitus: Meta-analyses of Clinical Outcomes

Technology and Condition

Long-acting insulin analogues used as basal insulin, insulin glargine (IGlar) and insulin detemir (IDet), for the treatment of type 1 and 2 diabetes mellitus (DM).

Issue

More than 2.25 million Canadians have DM. The annual cost of treating DM and its complications is more than $9 billion. The successful management of DM often requires medications. Insulin analogues cost more than human insulin (HI). There is uncertainty about whether the use of insulin analogues is justified.

Methods and Results

A systematic review and a meta-analysis were undertaken to evaluate the clinical and economic implications of using long-acting analogues for the treatment of DM, relative to human insulin and to oral anti-diabetic agents. A total of 34 randomized controlled trials were eligible for review: 23 trials of patients with type 1 DM and 11 trials on type 2 DM. Meta-analysis was performed using trials that completely reported data. The budget impact to publicly funded provincial drug plans was also examined.

Implications for Decision Making

  • Long-acting insulin analogues (LAIAs) have no demonstrated impact on blood sugar control. The available evidence suggests that LAIAs have not demonstrated clinically important differences in glycated hemoglobin, a widely used marker of blood sugar control in types 1 and 2 DM.
  • Reduced complications from therapy can occur. The evidence suggests IGlar can reduce the risk of severe hypoglycemia in type 1 DM patients taking human insulin. IGlar reduced the risk of nocturnal but not severe hypoglycemia in type 2 DM patients. IDet has demonstrated a reduced risk of severe and nocturnal hypoglycemia in type 1 DM. No reductions in complications with IDet were observed in patients with type 2 DM.
  • Funding decisions may require more compelling economic evidence. Publicly funding LAIAs will require significant additional investment. Economic arguments for this investment are limited largely because they are based on unproven assumptions about the long-term benefit of therapy.

This summary is based on a comprehensive health technology assessment available from CADTH’s web site (www.cadth.ca): Tran K, Banerjee S, Li H, Cimon K, Daneman D, Simpson S, Campbell K. Long-acting insulin analogues for diabetes mellitus: meta-analysis of clinical outcomes and assessment of cost-effectiveness [Technology Report number 92]. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2007.