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

Authors

  • Maurílio de Souza Cazarim University of São Paulo; School of Pharmaceutical Sciences of Ribeirão Preto; Pharmaceutical Services and Clinical Pharmacy Research Center
  • João Paulo Vilela Rodrigues University of São Paulo; School of Pharmaceutical Sciences of Ribeirão Preto; Pharmaceutical Services and Clinical Pharmacy Research Center
  • Estael Luzia Coelho da Cruz-Cazarim University of São Paulo; School of Pharmaceutical Sciences of Ribeirão Preto; Pharmaceutical Services and Clinical Pharmacy Research Center
  • Lorena Rocha Ayres Federal University of Espirito Santo; Department of Pharmaceutical Sciences
  • Leonardo Régis Leira Pereira University of São Paulo; School of Pharmaceutical Sciences of Ribeirão Preto; Pharmaceutical Services and Clinical Pharmacy Research Center

DOI:

https://doi.org/10.1590/s2175-97902017000300178

Keywords:

Diabetes Mellitus/treatment/cost-effectiveness/evaluation, Prolonged Action Insulin, Short Action Insulin, Brazilian Public Health System

Abstract

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.

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Published

2017-01-01

Issue

Section

Articles

How to Cite

Cost-effectiveness of insulin analogs from the perspective of the Brazilian public health system. (2017). Brazilian Journal of Pharmaceutical Sciences, 53(3), e00178-. https://doi.org/10.1590/s2175-97902017000300178